Spinal muscular atrophy treatment via targeting smn2 catalytic core

ABSTRACT

The present invention is directed to methods and compositions for blocking the effect of the intronic inhibitory splicing region of intron 7 of the SMN2 gene. The compositions and methods of the instant invention include short oligonucleotide reagents (e.g., oligoribonucleotides) that effectively target sites in the SMN2 pre-mRNA, thereby modulating the splicing of SMN2 pre-mRNA to include exon 7 in the processed transcript. The short target regions are 8-mers and 5-mers and also include the identification of a single nucleotide base that is essential for initiating a long distance stearic inhibitory interactions as well as novel targets distant from intron 7 which block the intronic inhibitory splicing of the same. These short target regions and concomitant inhibitory blocking oligonucleotides are less expensive and easier to manufacture and are small enough to cross the blood brain barrier.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority under 35 U.S.C. §119 to provisionalapplication Ser. No. 61/343,373 filed Apr. 28, 2010, herein incorporatedby reference in its entirety.

GRANT REFERENCE

This invention was made with government support under NIH Grant No. 7R01 NS055925 awarded by the United States National Institutes of Health.The government has certain rights in the invention.

BACKGROUND OF THE INVENTION

Alternative splicing increases the coding potential of human genome byproducing multiple proteins from a single gene (Black, D. L. 2003. Annu.Rev. Biochem. 72:291-336). It is also associated with a growing numberof human diseases (Faustino, N. A., and T. A. Cooper. 2003. Genes Dev.17:419-437; Garcia-Blanco, M. A., et al. 2004. Nat. Biotechnol.22:535-546; Pagani, F., and F. E. Baralle. 2004. Nat. Rev. Genet.5:389-396).

Spinal Muscular Atrophy (SMA) is an often-fatal genetic disorderresulting from the loss of the Survival Motor Neuron (SMN) proteinencoded by the Survival Motor Neuron (SMN) gene. The SMN genes, SMN1 andSMN2, are located on chromosome 5 and SMA is caused by the loss of SMN1from both chromosomes. SMN2, while being almost identical to SMN1, isless effective at making the SMN protein. The severity of SMA isaffected by the efficiency at which SMN2, of which there are severalcopies, produces the SMN protein.

SMN1 encodes a ubiquitously expressed 38 kDa SMN protein that isnecessary for snRNP assembly, an essential process for cell survival(Wan, L., et al. 2005. Mol. Cell. Biol. 25:5543-5551). A nearlyidentical copy of the gene, SMN2, fails to compensate for the loss ofSMN1 because of exon 7 skipping, producing an unstable truncatedprotein, SMNΔ7 (Lorson, C. L., et al. 1998. Nat. Genet. 19:63-66). SMN1and SMN2 differ by a critical C to T substitution at position 6 of exon7 (C6U in transcript of SMN2) (Lorson, C. L., et al. 1999. Proc. Natl.Acad. Sci. USA 96:6307-6311; Monani, U. R., et al. 1999. Hum. Mol.Genet. 8:1177-1183). C6U does not change the coding sequence, but issufficient to cause exon 7 skipping in SMN1.

Current treatment for SMA consists of prevention and management of thesecondary effect of chronic motor unit loss. Currently, there are nodrug therapies available for the treatment or prevention of SMA.

Antisense technology, used mostly for RNA downregulation, recently hasbeen adapted to alter the splicing process (Kole et al., Acta BiochimPol. (2004) 51, 373-8). Techniques that trick the splicing machinery toalter splicing of SMN2 pre-mRNAs are likely to have high therapeuticvalue.

SUMMARY OF THE INVENTION

The present invention is based, in part, on the discovery that antisensetargeting, displacement and/or disruption of an intronic sequence in theSMN2 gene can enhance production of full-length SMN2 transcripts(transcripts containing exon 7) during splicing. In particular, thepresent inventors have identified critical regions of the intron 7 whichmust be included to be work as a desirable therapeutic target.Accordingly, the invention is directed to effective use of blockingagents, targeting this critical region. According to the invention,Applicants have identified a short target comprising no more than 8nucleotides which is effective as a therapeutic target. In anotherembodiment, Applicants have identified a single critical base, ¹⁰C whichmust be targeted and which interacts with distant sequences in a stearicfashion to repair intron splicing. Quite surprisingly, Applicants havefound that this critical base, and sequences 5′ thereof, which do notinclude any previously known target motifs work better than any targetsdiscovered to date, and create the opportunity to generate sequences asshort as 5-mers that are effective in repairing splicing. The inventionthus includes, blocking oligonucleotide reagents (e.g., modifiedantisense oligoribonucleotides) to inhibit these critical intronicsplice-inhibitory sequences. Treatment of cells derived from SMApatients with the oligonucleotide reagent compositions of the instantinvention will effectively restore the production of the full-length SMNprotein. These results demonstrate for the first time a stearic distantinteraction between an oligonucleotide reagent and inhibition of an SMN2splice site inhibitory domain. This distant interaction also provides anovel target site for inhibition of the intron 7 aberrant splicing andincludes oligonucleotides designed to block a ¹⁰C interacting region ofintron 7.

Prior work by the inventors and others had discovered the ISS-N1,CCAGCAUUAU GUUUG (SEQ ID NO:1) an intronic element that harbors twoputative hnRNP A1 binding sites (CAGCAU and UGAAAG) as a primary targetfor SMN2. Applicants here show that much shorter targets are effective,in fact even targets that do not include either of the hnRNP Al site,and which include sequences which are 5′ of the ISS-N1 target.

The present invention therefore is directed to compositions capable ofblocking the inhibitory effects of the newly-discovered SMN2 shortenedand critical intronic splice silencing domain. Agents capable ofblocking the splice-inhibitory effect of this domain have high value asSMA therapeutics. Featured agents capable of blocking thesplice-inhibitory effect of the SMN2 shortened domain include, but arenot limited to, e.g., agents that disrupt the interaction of an targetdomain-interacting protein with the target sequence, agents thatsequester a target interacting protein, agents that disrupt thestructure of the target domain and/or surrounding regions.

In exemplary embodiments, the instant invention is directed tooligonucleotide reagents (e.g., modified antisense oligoribonucleotides)that block the effect on pre-mRNA splicing of the SMN2 sequence viadirect interaction and/or hybridization with the target sequence. SuchRNA-complementary oligonucleotide reagents may be modified byart-recognized means to improve their in vivo stabilities and/orbioaccessibility. The instant invention also is directed to methods foridentifying target domain-interacting proteins, as such methods areenabled by discovery and characterization of the target sequence.

In one aspect, the instant invention is directed to an isolatedoligonucleotide reagent (e.g., an oligoribonucleotide) comprising anucleotide sequence which is complementary to an SMN2 target comprising8 bases or even surprisingly 5 or less bases in length and which alsoincludes the critical ¹⁰C base in the target sequence. These shorteroligonucleotides are easier and less expensive to manufacture and aresmall enough to cross the blood brain barrier, making them especiallybeneficial for use therapeutics.

In another aspect, the instant invention is directed to an isolatedoligonucleotide reagent (e.g., an oligoribonucleotide) which iscomplementary to the 8mer sequence 5′-CUGCCAGC-3′.

In an additional aspect, the instant invention is directed to anisolated oligonucleotide reagent (e.g., an oligoribonucleotide) which iscomplementary to the 5mer sequence 5′-GUGCC-3′.

In a further aspect, the instant invention is directed to an isolatedoligonucleotide reagent (e.g., an oligoribonucleotide) which iscomplementary to a sequence which includes the ¹⁰C and sequence 5′thereof.

In another aspect, the instant invention is directed to an isolatedoligonucleotide reagent (e.g., an oligoribonucleotide) which is greaterthan 90% complementary to the sequence 5′-5′-CUGCCAGC-3′, or GUGCC.

In an additional aspect, the instant invention is directed to anisolated oligonucleotide sequence comprising the sequence5′-GCUGGCAG-3′.

In another aspect, the instant invention is directed to an isolatedoligonucleotide sequence comprising the sequence 5′-GGCAG-3′.

In another aspect, the instant invention is directed to an isolatedoligonucleotide reagent comprising a sequence greater than 80% identicalto the sequence 5′-GCUGGCAG-3′ or 5′-GGCAG-3′.

In one embodiment, the oligonucleotide is modified by the substitutionof at least one nucleotide with a modified nucleotide, such that in vivostability is enhanced as compared to a corresponding unmodifiedoligonucleotide. In a related embodiment, the modified nucleotide is asugar-modified nucleotide. In another embodiment, the modifiednucleotide is a nucleobase-modified nucleotide.

In an additional embodiment, the modified nucleotide is a 2′-deoxyribonucleotide. In certain embodiments, the 2′-deoxy ribonucleotide is2′-deoxy adenosine or 2′-deoxy guanosine. In another embodiment, themodified nucleotide is a 2′-O-methyl (e.g., 2′-O-methylcytidine,2′-O-methylpseudouridine, 2′-O-methylguanosine, 2′-O-methyluridine,2′-O-methyladenosine, 2′-O-methyl) ribonucleotide. In an additionalembodiment, the modified nucleotide is selected from the groupconsisting of a 2′-fluoro, 2′-amino and 2′-thio modified ribonucleotide.In a further embodiment, the modified nucleotide is selected from thegroup consisting of 2′-fluoro-cytidine, 2′-fluoro-uridine,2′-fluoro-adenosine, 2′-fluoro-guanosine, 2′-amino-cytidine,2′-amino-uridine, 2′-amino-adenosine, 2′-amino-guanosine and2′-amino-butyryl-pyrene-uridine. In an additional embodiment, themodified nucleotide is selected from the group consisting of5-bromo-uridine, 5-iodo-uridine, 5-methyl-cytidine, ribo-thymidine,2-aminopurine, 5-fluoro-cytidine, and 5-fluoro-uridine,2,6-diaminopurine, 4-thio-uridine, and 5-amino-allyl-uridine.

In a further embodiment, the modified nucleotide is a backbone-modifiednucleotide. In one embodiment, the backbone-modified nucleotide containsa phosphorothioate group. In another embodiment, the modified nucleotideis a locked nucleic acid (LNA).

Another embodiment is directed to a composition comprising anoligonucleotide of the invention. In certain embodiments, thecomposition further comprises a pharmaceutical carrier.

An additional embodiment of the invention is directed to a method ofenhancing the level of exon 7-containing SMN2 mRNA relative toexon-deleted SMN2 mRNA in a cell or cell extract, comprising contactingthe cell or sell extract with an oligonucleotide (e.g., anoligoribonucleotide) of the invention, such that the level of exon7-containing SMN2 mRNA relative to exon-deleted SMN2 mRNA in the cell orcell extract is enhanced. In one embodiment, the cell or cell extract isa spinal muscular atrophy (SMA) patient-derived neuronal cell, musclecell or fibroblast, or extract thereof. In certain embodiments, the cellor cell extract is selected from the group consisting of an embryonicstem cell, an embryonic stem cell extract, a neuronal stem cell and aneuronal stem cell extract.

A related embodiment of the invention is directed to a method ofenhancing the level of exon 7-containing SMN2 mRNA relative toexon-deleted SMN2 mRNA in an organism, comprising administering to theorganism an oligonucleotide of the invention (e.g., anoligoribonucleotide), such that the level of exon 7-containing SMN2 mRNArelative to exon-deleted SMN2 mRNA in the organism is enhanced. In oneembodiment, the organism is a mammal. In another embodiment, theorganism is a human. In certain embodiments, the human has spinalmuscular atrophy (SMA).

Another embodiment of the invention is directed to a method of treatingspinal muscular atrophy (SMA) in a patient, comprising administering tothe patient an oligonucleotide of the invention (e.g., anoligoribonucleotide) in a dose effective to enhance the level of exon7-containing SMN2 mRNA relative to exon-deleted SMN2 mRNA in cells ofthe patient, such that SMA in the patient is treated.

A further embodiment is directed to a method for inhibiting an SMN2pre-mRNA intronic splicing silencer site in a cell or cell extractcomprising contacting the cell with an oligonucleotide of the invention(e.g., an oligoribonucleotide), such that the SMN2 intronic splicingsilencer site is inhibited. In a related embodiment, the instantinvention is directed to a method for inhibiting an SMN2 pre-mRNAintronic splicing silencer site in an organism comprising administeringto the organism an oligonucleotide of the invention, such that the SMN2intronic splicing silencer site is inhibited. Another embodiment isdirected to a method for inhibiting an SMN2 pre-mRNA intronic splicingsilencer site in a subject with SMA comprising administering to thesubject an oligonucleotide of the invention (e.g., anoligoribonucleotide), such that the SMN2 intronic splicing silencer siteis inhibited.

An additional aspect of the invention is directed to a method foridentifying a protein that interacts with the sequences set forth asherein, SEQ ID NOS:2 -5, comprising contacting a cell or cell extractwith the sequence under conditions sufficient for the sequence tointeract with a protein in the cell or cell extract; and isolating thesequence and interacting protein, such that the protein that interactswith the target sequence is identified. In one embodiment, the methodfurther comprises UV-crosslinking the sequence to the interactingprotein. In an additional embodiment, the cell or cell extract is ofmammalian origin. In certain embodiments, the cell or cell extract is ofhuman origin.

Another aspect of the invention is directed to a method of enhancing thelevel of exon 7-containing SMN2 mRNA relative to exon-deleted SMN2 mRNAin a cell or cell extract, comprising contacting the cell or cellextract with an oligonucleotide or nucleotide targeted blocking agent ofthe invention, such that the level of exon 7-containing SMN2 mRNArelative to exon-deleted SMN2 mRNA in the cell or cell extract isenhanced. A related aspect of the invention is directed to a method ofenhancing the level of exon 7-containing SMN2 mRNA relative toexon-deleted SMN2 mRNA in an organism, comprising contacting theorganism with an nucleotide SNM2 blocking agent, such that the level ofexon 7-containing SMN2 mRNA relative to exon-deleted SMN2 mRNA in theorganism is enhanced.

In one embodiment, the blocking agent is selected from the groupconsisting of a small molecule, a peptide, a polynucleotide, an antibodyor biologically active portion thereof, a peptidomimetic, and anon-peptide oligomer. In an additional embodiment, the blocking agent isa small molecule.

In an additional aspect, the invention is directed to a method oftreating amyotrophic lateral sclerosis (ALS) in a patient, comprisingadministering to the patient the oligonucleotide of the invention in adose effective to enhance the level of exon 7-containing SMN2 mRNArelative to exon-deleted SMN2 mRNA in cells of the patient.

In an additional embodiment, the oligonucleotide reagent of theinvention is a ribozyme.

Other features and advantages of the invention will be apparent from thefollowing detailed description and claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. An ultra-refined antisense micro-walk reveals the significanceof a cytosine residue at the 10^(th) position (¹⁰C) of SMN2 exon 7. (A)Diagrammatic representation of cis-elements at the 5′ end of SMN2 intron7. ISS-N1 is highlighted in yellow with all but the first nucleotideshown in red. Two hnRNP Al motifs are indicated as described in (Hua etal. 2008). GC-rich sequence is highlighted in green (Singh et al. 2009).Numbering of nucleotides starts from the first position of SMN2 intron7. The location of ¹⁰C is marked by an arrow. (B) Diagrammaticrepresentation of ASOs and their annealing positions relative to ISS-N1region. Numbering of nucleotides starts from the first position ofintron 7. Boundaries of ISS-N1 are demarcated. The first ISS-N1 residue,¹⁰C, is highlighted in blue. The GC-rich sequence (Singh et al. 2009) ishighlighted in green. The core sequence of the antisense target ishighlighted in yellow. ASOs are shown as horizontal bars. Green barsrepresent ASOs that promote SMN2 exon 7 inclusion (exon 7 skipping is45% and less). The intensity of green color reflects the strength of ASOstimulatory effect. Grey bars represent ASOs that have no effect on SMN2exon 7 inclusion. Pink bars represent ASOs that promoted SMN2 exon 7skipping (exon 7 skipping is 55% and more). To emphasize that L14 causedthe most dramatic increase in exon 7 skipping, it is shown as a darkpink bar. (C) Splicing pattern of endogenous SMN2 after treatment withASOs shown in panel B. SMA type I patient fibroblasts (GM03813) weretreated with 20 nM of different ASOs and the total RNA for in vivosplicing assay was isolated 24 h post transfection. The upper bandcorresponds to exon 7-included product; the lower band corresponds toexon 7-skipped product. The percentage of exon skipping was calculatedfrom the total value of exon-included and exon-skipped products. Thevalues represent mean of three independent experiments. The standarddeviations were less than 5% of mean. The effect of F14 and L14 arehighlighted with green and red box, respectively. (D) Splicing patternof endogenous SMN2 after treatment with 50 nM of indicated ASOs. Thechemistry of the ASOs used is shown on the right. In vivo splicingassays were performed and analyzed as described in panel C. The valuesrepresent mean of three independent experiments. The standard deviationswere less than 5% of mean.

FIG. 2. Effect of ASOs are specific to their targets. (A) Diagrammaticrepresentation of the target area in intron 7 of SMN2 minigene. ISS-N1is highlighted in light gray. Numbering of nucleotides starts from thefirst position of intron 7. The location of ¹⁰C is marked by an arrow.The sequences of four ASOs and their annealing positions in ISS-N1region are shown. Mutations are indicated in white letters andhighlighted in black. Effect of ASOs on splicing of SMN2 minigene isshown on the right. HeLa cells were co-transfected with 50 nM of a givenASO and 0.1 μg of SMN2 minigene. Splicing was determined 24 h aftertransfection. The percentage of exon 7 skipping was calculated asdescribed in FIG. 1C. (B) Diagrammatic representation of the target areain intron 7 of SMN2/I7-08 minigene. ISS-N1 is highlighted in gray.Numbering of nucleotides starts from the first position of intron 7.Location of ¹⁰C is marked by an arrow. Sequences of four ASOs and theirannealing positions are shown. Mutations in ISS-N1 area as well as inthe ASOs are indicated in white letters and highlighted in black. Effectof the ASOs on splicing of SMN2/I7-08 minigene is shown on the right. Invivo splicing assays were performed and analyzed as described in panelA.

FIG. 3. Sequestration of ¹⁰C decides the outcome of antisense response.Numbering of nucleotides starts from the first intronic position. ISS-N1sequence is highlighted in grey. The first C residue in ISS-N1 is markedas ¹⁰C (A) Diagrammatic representation of the 5′ portion of intron 7 ofSMN2 minigene and its mutant, SMN2/Δ64. The location of ¹⁰C and itsdeletion are indicated. Effect of ASOs on splicing of wild type andmutated SMN2 minigene is shown on the right. Co-transfections andanalyses were done as in (FIG. 2A). (B) Diagrammatic representation ofwild type and mutated ISS-N1 targeted by different ASOs. Sequences ofASOs and their base pairing with the corresponding target are shown.Note that wild type and mutated ISS-N1 element are located within intron7 of SMN2 and SMN2/64A minigene, respectively. Arrows mark ¹⁰C and ¹⁰Apositions. The 3′-overhang of ASOs are highlighted. Effect of ASOs onsplicing of SMN2 minigene and its mutant, SMN2/64A, is shown in thebottom panel. Co-transfections and splicing analyses were done as in(FIG. 2A).

FIG. 4. Effect of the local context on antisense response ofISS-N1-targeting ASOs. (A) Diagrammatic representation of the targetarea in intron 7 of SMN2 minigene and its four mutants. ISS-N1 ishighlighted in grey. The first C residue in ISS-N1 is marked as ¹⁰C or¹⁵C depending on its position relative to the beginning of intron 7. Ofnote, numbering of intronic residues starts with the first position ofintron 7. Five-nucleotide-long insertions immediately upstream of ISS-N1in SMN2/5A or SMN2/5G minigenes are boxed and shown in capital letters.(B) In vivo splicing pattern of wild type and mutant SMN2 minigenesshown in panel A. The minigenes were co-transfected with an ASO ofinterest. Co-transfections and splicing analysis were done similarly asin (FIG. 2A).

FIG. 5. Effect of the heterologous context on antisense response ofISS-N1-targeting ASOs. (A) Diagrammatic representation of exon 6/intron6 junction in Casp3 minigene variants. 3′-Cluster and ISS-N1, which areshaded in grey, were inserted either individually or together3-nucleotide upstream and 9-nucleotide downstream of the exon/intronjunction, respectively. In Casp3-SMN5′-1 minigene the entire region fromthe beginning of 3′-Cluster to the end of ISS-N1 corresponds to SMNsequence. The last three nucleotides of SMN exon 7 and the first ninenucleotides of SMN intron 7 are highlighted in black. As a result ofthis insertion, Casp3 exon 6 now has the 5′ ss of SMN exon 7 followed byISS-N1 element. The location of ¹⁰C is marked by an arrow. (B) Effect of3′-Cluster and ISS-N1 insertions on Casp3 exon 6 splicing. HeLa cellswere transfected with 0.8 μg of Casp3 minigene variant and the total RNAfor in vivo splicing assay was isolated 24 h post transfection. Exon6-included and exon 6-skipped spliced products are indicated. Percentageof exon skipping was calculated from the total value of exon-includedand exon-skipped products similarly as in FIG. 2. (C) In vivo splicingpatterns of two Casp3 minigene variants in the presence of ASOs.Co-transfections and splicing analysis were done as in FIG. 2A. (D) Invivo splicing patterns of Casp3SMN2 minigene in the presence of ASOs.Diagram explaining the composition of this hybrid minigene is shown onthe top. Co-transfections and splicing analysis were done as in panel C.

FIG. 6. Effect of deletions within intron 6 and intron 7 on antisenseresponse of ISS-N1-targeting ASOs. (A) Diagrammatic representation ofthe deleted regions in intron 6 and 7 of SMN2 minigene. Deletions arerepresented by dotted lines. Positive numbers indicate nucleotidepositions within intron 7 and start from the first position of thisintron. Negative numbers indicate nucleotide positions within intron 6and start from the last position of this intron. Names of mutants aregiven on the left; numbers in names reflect positions of the first andthe last deleted nucleotides. A deletion mutant producing a stimulatoryeffect in presence of an ASO is shown as plus, whereas a mutantproducing a negative effect in presence of an ASO is shown as minus. (B)In vivo splicing pattern of wild type and mutant SMN2 minigenes shown inpanel A. Minigenes were co-transfected with an ASO of interest.Co-transfections and splicing analyses were done similarly as in FIG.2A.

FIG. 7. Effect of deletions within intron 7 on antisense response ofISS-N1-targeting ASOs. (A) Diagrammatic representation of the deletedregions within intron 7 of SMN2 minigene. Deletions are represented bydotted lines. Numbers indicate nucleotide positions and start from thefirst position of intron 7. Names of mutants are given on the left;numbers in the names reflect positions of the first and the last deletednucleotides. A deletion mutant producing a stimulatory effect inpresence of an ASO is shown as plus, whereas a mutant producing anegative effect in presence of an ASO is shown as minus. (B) In vivosplicing pattern of mutant SMN2 minigenes shown in panel A. Minigeneswere co-transfected with an ASO of interest. Co-transfections andsplicing analysis were done similarly as in FIG. 2A.

FIG. 8. Site-specific UV-crosslinking of purified recombinant hnRNP A1with ISS-N1. (A) Purification of recombinant hnRNP A1 protein expressedfrom pTXB3-A1 in E. coli ER2566 strain. Protein was purified by bindingto a chitin affinity column, followed by DTT-induced self-cleavage ofthe Mycobacterium xenopi GyrA intein. Sample aliquots were collected atdifferent purification steps and used for SDS-polyacrylamide gelelectrophoresis. Lane 1, molecular weight markers; lane 2, clarifiedlysate; lane 3, flow through from the column; lanes 4 & 5, wash withincreasing concentration of NaCl; lane 6, DTT flush; lane 7, pooledhnRNP A1-containing fractions eluted after overnight DTT-induced inteinself-cleavage at 4° C. Band corresponding to hnRNP A1 is indicated by anarrow. Right panel shows the diagrammatic representation of pTXB3-A1construct. This construct contains hnRNP A1 ORF with a C-terminus fusedin frame to the Mycobacterium xenopi GyrA intein/chitin binding domain(CBD). (B) Diagrammatic representation of steps for site-specific³²P-labeling of RNA probe. The sequence of probe and its relativelocation within SMN are given. ISS-N1 is highlighted in yellow and itssequence shown in red letters. Position of the ³²P-radioisotopeincorporation is indicated by a star. The sequence of the bridging DNAoligonucleotide is shown in green. (C) Autoradiogram showing hnRNPA1-crosslinked product. Site-specifically ³²P-labeled RNA probe wasUV-crosslinked with purified recombinant hnRNP A1 followed by RNasedigestion and fractionation on 13% SDS-polyacrylamide gel. (D)UV-crosslinking in the presence of different ASOs under “denaturing”condition. Here, RNA probe was first refolded in the presence of acorresponding ASO to insure ASO annealing. After that the purified hnRNPA1 was added to the reaction mixture followed by UV-crosslinking.Analysis of hnRNP A1-crosslinked products was done as in panel C. (E)UV-crosslinking in the presence of different ASOs under “native”condition. Here the RNA probe was denatured and refolded prior to an ASOand hnRNP A1 addition to the reaction mixture. UV-crosslinking reactionand analysis of the products were performed as in panel C.

FIG. 9. Model of SMN2 exon 7 splicing modulation by ¹⁰C in the presenceof L14 and F14. (A) L14 Pathway: L14 leaves ¹⁰C unsequestered andaccessible for a long-distance interaction with intronic sequencesupstream of the branch point. This arrangement interferes with thecatalytic core formation at the 5′ ss of exon 7. Consequently, thecompeting 5′ ss of exon 6 becomes the favorable substrate for thetransesterification reaction leading to exon 7 skipping. (B) F14Pathway: F14 sequesters ¹⁰C and prevents a long-distance interactionwith intronic sequences upstream of the branch point. This arrangementfavors catalytic core formation at the 5′ ss of exon 7. Consequently,SMN2 exon 7 inclusion is promoted.

FIG. 10 is a diagram showing intron 7 and the long distance target sitesfor additional oligos.

FIG. 11. Ultra-refined antisense microwalk to identify the shorteststimulatory ASO. (A) Diagrammatic representation of ASOs targetingsequences upstream of ISS-N1. Exon 7 is boxed and the first 24 residuesof human SMN intron 7 are shown. Numbering starts from the firstposition of intron 7. The 5′ ss of exon 7 is indicated by a verticalarrow. ASOs blocking different regions are shown as horizontal bars.Sequences of these ASOs are given in Table A. Boundary of ISS-N1 isdemarcated. hnRNP A1 motifs are indicated. Green bars represent ASOsthat promote SMN2 exon 7 inclusion. Intensity of green color reflectsthe strength of stimulatory effect. Tan bars represent ASOs that have noeffect on SMN2 exon 7 inclusion. Area highlighted in pink represents theonly GC-rich sequence in the first half of human intron 7. Areahighlighted in light blue represents the core sequence of the antisensetarget. Right panel shows the relative positioning of ISS-N1, GC-richsequence in the context of predicted RNA structure. Green bar represents3UP8, the shortest ASO to stimulate SMN2 exon 7 inclusion. (B) Splicingpattern of endogenous SMN2 in SMA type I patient fibroblasts (GM03183)treated with different ASOs. Cells were transfected with 20 nM of 2OMePSASOs and the total RNA for splicing assay was isolated 24 h posttransfection. Results were analyzed as described earlier. 3UP8 was theshortest ASO to show stimulatory response (highlighted by green box).

FIG. 12. Antisense effect is specific to its target sequence. (A)Diagrammatic representation of intron 7 of SMN2 minigene and its mutant,SMN2/64A. Numbering starts from the first position of human SMN intron7. ISS-N1 sequence is highlighted in gray. Mutated residue ishighlighted in black. (B) Effect of ASOs on splicing of SMN2 minigeneand its mutant, SMN2/64A. HeLa cells were transfected with 50 nM of agiven ASO and 0.1 μg of minigene in a 24-well plate. Splicing wasdetermined 24 h after transfection. Results were analyzed as describedearlier.³⁵

FIG. 13. Effect of ASOs on alternative splicing of different exons ofendogenous SMN2. SMA type I patient fibroblasts (GM03183) weretransfected with 20 or 100 nM of selected ASOs in 6-well plates. Thetotal RNA for splicing assay was isolated 24 h post transfection.Spliced products were amplified by RT-PCR with one of the primers beingend-labeled. Annealing positions of primers are shown by bars. (A) Leftpanel depicts the diagrammatic representation of expected splicedproducts. Right panel shows the results of RT-PCR. Exon 7 skipped, exon5 skipped and co-excluded products are marked. (B) Left panel depictsthe diagrammatic representation of expected spliced products due toskipping of exon 5. Right panel shows the results of RT-PCR. Exon 5included and exon 5 skipped products are marked. (C) Left panel depictsthe diagrammatic representation of expected spliced products due toskipping of exon 3. Right panel shows the results of RT-PCR. Exon 3included and exon 3 skipped products are marked.

FIG. 14. Effect of the shortest stimulatory ASO (3UP8) on levels ofcellular proteins in SMA patient cells. (A) Western blot showing theeffect of different ASOs. SMA type I patient cells (GM03183) weretransfected with 40 nM of selected ASOs and cells were harvested 48 hafter transfection. Left panel represents the results of western blot ofdifferent proteins, whereas the right panel represents the results ofRT-PCR. (B) Time course of 3UP8 effect on the levels of SMN and otherfactors. SMA type I patient cells (GM03183) were transfected with asingle dose of 40 nM of 3UP8 and harvested after every 24 h for sixdays. Left panel represents the results of western blot of differentproteins, whereas the right panel represents the results of RT-PCR.

FIG. 15. Confocal images confirming that treatment with short ASO (3UP8)promotes nuclear accumulation of SMN in SMA patient cells. Thefibroblasts from SMA type I patient (GM03813) were cultured oncoverslips and transfected with 40 nM of F8 (control) or 3UP8CY3-labeled ASOs. Cells were fixed 48 h after transfection and stainedwith anti-SMN (Green) and anti-ZPR1 (Red) antibodies. Cells transfectedwith ASOs were detected by Cy3 fluorescence and presented inpseudo-color (Cyan). DNA was stained with DAPI (blue). The scale bar is10 mm.

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to the discovery that targeting of a verysmall regions even a single critical nucleotide within intron 7 of theSMN2 gene can enhance production of full-length SMN2 transcripts(transcripts containing exon 7) during splicing. In particular, thepresent inventors have identified a small target sequence and a criticalsingle nucleotide for design of novel intronic inhibitory sequenceelements. Previous targets and inhibitory sequence elements included a15 mer named ISS-N1 (for “intronic splicing silencer”), in the SMN2 geneas a therapeutic target. This target included two hnRNP motifs that werethought to be critical for therapeutic activity of the inhibitoryelements. Quite the contrary Applicants have found that much smallertargets may be used, including an 8-mer that only targets a portion ofthe first hnRNP motif and most surprisingly a 5-mer that includes onlysingle base of the hnRNP A1. Instead of targeting the hnRNP A1,Applicants have identified a critical single nucleotide in intron 7 ¹⁰Cthat is at the catalytic core of SMN and is critical for inhibitoryactivity. Applicants herein demonstrate that the inhibitory affect onunpaired ¹⁰C is dependant on a long-distance interaction involvingdownstream intronic sequences and represents a target design strategyfor inhibiting elements that is based not a linear motif but instead onlong-distance stearic interactions.

Accordingly, the invention is directed to effective use of blockingcompounds, in particular, oligonucleotide reagents (e.g., modifiedantisense oligoribonucleotides) to inhibit this intronicsplice-inhibitory sequence. The 8-mer and 5-mer and ¹⁰C sequence motifswas identified to play a dominant role in production of exon 7-deletedSMN2 transcripts. ̂-mer and 7mers did not produce sufficient inhibitoryactivity. Oligoribonucleotide reagents complementary the 5-mer and 8 merregion and those which included ¹⁰C will enhance inclusion of exon 7during splicing of SMN2 transcript in SMA fibroblasts, thus restoringproduction of full-length SMN2 mRNA transcripts.

The invention is also directed to therapies that displace and/or disruptthe critical target sequences identified herein. These resultsdemonstrated for the first time a critical single base target for longdistance interaction and inhibition of SMN2 splice site inhibitorydomains.

The present invention provides compositions for blocking the inhibitoryeffects of the SMN2 intronic splice silencing domain. In particular, theinvention provides compositions comprising oligonucleotide reagents(e.g., antisense agents or dsDNA cassettes) that block the spliceinhibitory effects of the intron 7 target sequences, thereby modulatingsplicing of the SMN2 pre-mRNA to include exon 7 in processed forms ofthe transcript. Agents capable of blocking the splicing effect of thisregion have high value as SMA therapeutics. Such agents can also be usedin treatment of diseases associated with high susceptibility tooxidative stress such as exposure to Paraquat and induced Parkinson'sdisease, as well as amyotrophic lateral sclerosis (ALS), anotherneurological disease characterized by low levels of SMN protein(Veldink, J. H., et al. 2005 Neurology 65(6):820-5). The inventiontherefore provides small agents capable of blocking thesplice-inhibitory effect of the SMN2 intron 7 which are small enough tocross the blood brain barrier, including but not limited to, e.g.,agents that disrupt the interaction of an intron 7-interacting proteinwith the target sequences disclosed herein, agents that sequester targetsequence interacting protein, agents that disrupt the structure of thetarget sequences herein and/or surrounding.

In exemplary embodiments, the instant invention is directed tooligonucleotide reagents capable of blocking the effect on pre-mRNAsplicing of the SMN2 target sequences via direct interaction and/orhybridization. To enhance the therapeutic value of suchRNA-complementary oligonucleotides, the invention is further directed tocompositions comprising modified forms of such oligonucleotides, e.g.,phosphorothioate-, 2′-O-methyl-, etc.-modified oligonucleotides, as suchmodifications have been recognized in the art as improving the stabilityof oligonucleotides in vivo. The instant invention also is directed tomethods for identifying target sequence-interacting proteins, as suchmethods are enabled by the instant discovery and characterization of thecritical target sequence and more specifically the single nucleotide ¹⁰Cwhich enables long distance interaction and inhibition.

So that the invention may be more readily understood, certain terms arefirst defined.

The term “nucleoside” refers to a molecule having a purine or pyrimidinebase covalently linked to a ribose or deoxyribose sugar. Exemplarynucleosides include adenosine, guanosine, cytidine, uridine andthymidine. The term “nucleotide” refers to a nucleoside having one ormore phosphate groups joined in ester linkages to the sugar moiety.Exemplary nucleotides include nucleoside monophosphates, diphosphatesand triphosphates. The terms “polynucleotide” and “nucleic acidmolecule” are used interchangeably herein and refer to a polymer ofnucleotides joined together by a phosphodiester linkage between 5′ and3′ carbon atoms.

The term “RNA” or “RNA molecule” or “ribonucleic acid molecule” refersto a polymer of ribonucleotides. The term “DNA” or “DNA molecule” ordeoxyribonucleic acid molecule” refers to a polymer ofdeoxyribonucleotides. DNA and RNA can be synthesized naturally (e.g., byDNA replication or transcription of DNA, respectively). RNA can bepost-transcriptionally modified. DNA and RNA can also be chemicallysynthesized. DNA and RNA can be single-stranded (i.e., ssRNA and ssDNA,respectively) or multi-stranded (e.g., double stranded, i.e., dsRNA anddsDNA, respectively). “mRNA” or “messenger RNA” is single-stranded RNAthat specifies the amino acid sequence of one or more polypeptidechains. This information is translated during protein synthesis whenribosomes bind to the mRNA.

The term “nucleotide analog” or “altered nucleotide” or “modifiednucleotide” refers to a non-standard nucleotide, including non-naturallyoccurring ribonucleotides or deoxyribonucleotides. Preferred nucleotideanalogs are modified at any position so as to alter certain chemicalproperties of the nucleotide yet retain the ability of the nucleotideanalog to perform its intended function. Examples of positions of thenucleotide which may be derivitized include the 5 position, e.g.,5-(2-amino)propyl uridine, 5-bromo uridine, 5-propyne uridine,5-propenyl uridine, etc.; the 6 position, e.g., 6-(2-amino)propyluridine; the 8-position for adenosine and/or guanosines, e.g., 8-bromoguanosine, 8-chloro guanosine, 8-fluoroguanosine, etc. Nucleotideanalogs also include deaza nucleotides, e.g., 7-deaza-adenosine; O- andN-modified (e.g., alkylated, e.g., N6-methyl adenosine, or as otherwiseknown in the art) nucleotides; and other heterocyclically modifiednucleotide analogs such as those described in Herdewijn, AntisenseNucleic Acid Drug Dev., August 2000 10(4):297-310.

Nucleotide analogs may also comprise modifications to the sugar portionof the nucleotides. For example the 2′ OH-group may be replaced by agroup selected from H, OR, R, F, Cl, Br, I, SH, SR, NH₂, NHR, NR₂, COOR,or OR, wherein R is substituted or unsubstituted C₁-C₆ alkyl, alkenyl,alkynyl, aryl, etc. Other possible modifications include those describedin U.S. Pat. Nos. 5,858,988, and 6,291,438.

The phosphate group of the nucleotide may also be modified, e.g., bysubstituting one or more of the oxygens of the phosphate group withsulfur (e.g., phosphorothioates), or by making other substitutions whichallow the nucleotide to perform its intended function such as describedin, for example, Eckstein, Antisense Nucleic Acid Drug Dev. April 200010(2): 117-21, Rusckowski et al. Antisense Nucleic Acid Drug Dev.October 2000 10(5):333-45, Stein, Antisense Nucleic Acid Drug Dev.October 2001 11(5): 317-25, Vorobjev et al. Antisense Nucleic Acid DrugDev. April 2001 11(2):77-85, and U.S. Pat. No. 5,684,143. Certain of theabove-referenced modifications (e.g., phosphate group modifications)preferably decrease the rate of hydrolysis of, for example,polynucleotides comprising said analogs in vivo or in vitro.

As used herein, the term “intronic splicing silencer-N1” or “ISS-N1”refers to the 15 mer sequence 5′-CCAGCAUUAUGAAAG-3′ previously known totarget intron 7.

The term “oligonucleotide” refers to a short polymer of nucleotidesand/or nucleotide analogs. An “oligonucleotide reagent” of the inventionincludes any agent, compound or composition that contains one or moreoligonucleotides, and includes, e.g., reagents comprising both singlestranded and/or double stranded (ds) oligonucleotide compositions,including, e.g., single stranded RNA, single stranded DNA, DNA/DNA andRNA/DNA hybrid compositions, as well as derivatized/modifiedcompositions thereof. Such “oligonucleotide reagents” may also includeamplified oligonucleotide products , e.g., polymerase chain reaction(PCR) products. An “oligonucleotide reagent” of the invention may alsoinclude art-recognized compositions designed to mimic the activity ofoligonucleotides, such as peptide nucleic acid (PNA) molecules.

The term “oligoribonucleotide” refers to a short polymer ofribonucleotides and/or ribonucleotide analogs.

An “oligoribonucleotide” of the invention can include one or a fewdeoxyribonucleotides or deoxyribonucleotide analogs in order to enhancethe stability and/or bioaccessibility of the molecule, however, thechemical nature of the entire molecule must be primarily of aribonucleotide nature in order that ISS-N1 blocking activity occursabsent degradation of the target RNA (i.e., absent the RNase Hdegradation triggered by oligodeoxyribonucleotides or DNA:RNAhybridization).

Preferably, the oligonucleotide reagent molecules/agents of theinvention act (or are effective) at a concentration (e.g., have an IC50)in the nanomolar range, for example, less than 500 nM, preferably lessthan 400 nM, more preferably less than 300, 250, 200, 150, 100, 75, 50,25, 10, 5, 2 or 1 nM.

Preferred oligonucleotide reagent molecules/agents are modifiedoligonucleotides having a length of about 5 to 50 nucleotides (ornucleotide analogs), e.g., 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16,17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34,35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50nucleotides (or nucleotide analogs). In preferred embodiments,oligonucleotide reagent molecules/agents are modified oligonucleotideshaving a length of about 15 to 40 nucleotides (or nucleotide analogs).In other embodiments, oligonucleotide reagent molecules/agents aremodified oligonucleotides having a length of about 3 to 80 nucleotides(or nucleotide analogs), or for example, about 3-10, 10-15, 15-20,20-25, 25-30, 30-35, 35-40, 40-45, 45-50, 50-55, 55-60, 60-65, 65-70,70-75, 75-80 or more nucleotides (or nucleotide analogs).

The term “agent” and “compound” are used interchangeably herein.

As used herein, the term “nuclease-resistant oligonucleotide” refers toany oligonucleotide that has been modified to inhibit degradation byenzymes such as, for example, the exonucleases known to be present inthe cytoplasm of a eukaryotic cell. RNA molecules (e.g., RNAoligonucleotides) are particularly at risk of degradation when combinedwith a composition comprising a cell extract or when introduced to acell or organism, and a “ribonuclease-resistant” oligonucleotide is thusdefined as an oligonucleotide reagent molecule/agent that is relativelyresistant to ribonuclease enzymes (e.g., exonucleases), as compared toan unmodified form of the same oligonucleotide. Preferredoligonucleotide reagent molecules/agents of the invention include thosethat have been modified to render the oligonucleotide relativelynuclease-resistant or ribonuclease-resistant. In a preferred embodiment,the oligonucleotide reagents of the invention have been modified with a2′-O-methyl group (e.g., 2′-O-methylcytidine, 2′-O-methylpseudouridine,2′-O-methylguanosine, 2′-O-methyluridine, 2′-O-methyladenosine,2′-O-methyl) and additionally comprise a phosphorothioate backbone.

The terms “2′-O-methyl modification”, “phosphorothioate modification”and “locked nucleic acid” (LNA; oligonucleotides comprising at least one2′-C,4′-C-oxy-methylene-linked bicyclic ribonucleotide monomer), as usedherein, possess their art-recognized meanings.

The term “antisense” refers generally to any approach reliant uponagents, e.g., single-stranded oligonucleotides, that are sufficientlycomplementary to a target sequence to associate with the target sequencein a sequence-specific manner (e.g., hybridize to the target sequence).Exemplary uses of antisense in the instant application involve use of anoligoribonucleotide agent that hybridizes to a target pre-mRNA moleculeand blocks an activity/effect (e.g., splicing pattern) of the targetedpre-mRNA sequence, but antisense approaches commonly are used to targetDNA or RNA for transcriptional inhibition, translational inhibition,degradation, etc. Antisense is a technology that can be initiated by thehand of man, for example, to modulate splicing and/or silence theexpression of target genes.

As used herein, the term “antisense oligonucleotide” refers to a nucleicacid (in preferred embodiments, an RNA) (or analog thereof), havingsufficient sequence complementarity to a target RNA (i.e., the RNA forwhich splice site selection is modulated) to block a region of a targetRNA (e.g., pre-mRNA) in an effective manner. In exemplary embodiments ofthe instant invention, such blocking of the ISS-N1 domain in SMN2pre-mRNA serves to modulate splicing, either by masking a binding sitefor a native protein that would otherwise modulate splicing and/or byaltering the structure of the targeted RNA. In preferred embodiments ofthe instant invention, the target RNA is target pre-mRNA (e.g., SMN2pre-mRNA). An antisense oligonucleotide having a “sequence sufficientlycomplementary to a target RNA sequence to modulate splicing of thetarget RNA” means that the antisense agent has a sequence sufficient totrigger the masking of a binding site for a native protein that wouldotherwise modulate splicing and/or alters the three-dimensionalstructure of the targeted RNA. Likewise, an oligonucleotide reagenthaving a “sequence sufficiently complementary to a target RNA sequenceto modulate splicing of the target RNA” means that the oligonucleotidereagent has a sequence sufficient to trigger the masking of a bindingsite for a native protein that would otherwise modulate splicing and/oralters the three-dimensional structure of the targeted RNA As usedherein, the terms “ISS-N1 blocking agent,” “ISS-N1 blocker,” and “ISS-N1blocking compound” refer to any agent (e.g., oligonucleotide,oligoribonucleotide, small molecule, etc.) that is capable of inhibitingthe effect of the SMN2 ISS-N1 site (e.g., lessen the inhibition of SMN2exon 7 inclusion during splicing that is caused by the ISS-N1 site).

As used herein, the term “antisense strand” as it pertains to anoligonucleotide reagent refers to a strand that is substantiallycomplementary to a section of about 10-50 nucleotides, e.g., about15-30, 16-25, 18-23 or 19-22 nucleotides of the pre-mRNA targeted formodulation of splicing. The antisense strand has sequence sufficientlycomplementary to the desired target pre-mRNA sequence to directtarget-specific modulation of RNA splicing (e.g., complementaritysufficient to trigger the formation of a desired target mRNA throughmodulation of splicing via, e.g., altered recruitment of the splicingmachinery or process).

As used herein, the “5′ end”, as in the 5′ end of an antisense strand,refers to the 5′ terminal nucleotides, e.g., between one and about 5nucleotides at the 5′ terminus of the antisense strand. As used herein,the “3′ end”, as in the 3′ end of a sense strand, refers to the region,e.g., a region of between one and about 5 nucleotides, that iscomplementary to the nucleotides of the 5′ end of the complementaryantisense strand.

An oligonucleotide reagent “that directs altered RNA splicing of a gene”is an oligonucleotide that has a sequence sufficiently complementary tothe target mRNA encoded by a gene to trigger altered splicing of thetarget mRNA by the splicing machinery or process, or, alternatively, isan oligonucleotide reagent that displaces and/or disrupts the sequenceof ISS-N1.

As used herein, the term “isolated sequence” (e.g., “isolatedoligonucleotide” or “isolated oligoribonucleotide”) refers to sequenceswhich are substantially free of other cellular material, or culturemedium when produced by recombinant techniques, or substantially free ofchemical precursors or other chemicals when chemically synthesized.

As used herein, the term “SMA” refers to spinal muscular atrophy, ahuman autosomal recessive disease that is often characterized byunderexpression of SMN protein in affected individuals.

The term “substituted”, particularly with respect to an alkyl, alkoxy,thioalkoxy, or alkylamino group, refers to replacement of a hydrogenatom on carbon with a heteroatom-containing substituent, such as, forexample, halogen, hydroxy, alkoxy, thiol, alkylthio, amino, alkylamino,imino, oxo (keto), nitro, cyano, or various acids or esters such ascarboxylic, sulfonic, or phosphonic. It may also refer to replacement ofa hydrogen atom on a heteroatom (such as an amine hydrogen) with analkyl, carbonyl or other carbon containing group.

As used herein, the term “target” refers to a RNA region, andspecifically, to a region identified by SEQ ID NO:1 through 5 at the5′-termini of the mRNA of the SMN2 intron 7 region which is responsiblefor the deletion of exon 7 and is associated with SMN.

The term “target sequence” refers to a portion of the target RNA againstwhich the oligonucleotide analog is directed, that is, the sequence towhich the oligonucleotide analog will hybridize by Watson-Crick basepairing of a complementary sequence.

The term “targeting sequence” is the sequence in the oligonucleotideanalog that is complementary (meaning, in addition, substantiallycomplementary) to the target sequence in the RNA genome. The entiresequence, or only a portion, of the analog compound may be complementaryto the target sequence. For example, in an analog having 20 bases, only12-14 may be targeting sequences. Typically, the targeting sequence isformed of contiguous bases in the analog, but may alternatively beformed of non-contiguous sequences that when placed together, e.g., fromopposite ends of the analog, constitute sequence that spans the targetsequence.

Target and targeting sequences are described as “complementary” to oneanother when hybridization occurs in an antiparallel configuration. Atargeting sequence may have “near” or “substantial” complementarity tothe target sequence and still function for the purpose of the presentinvention, that is, still be “complementary.” Preferably, theoligonucleotide analog compounds employed in the present invention haveat most one mismatch with the target sequence out of 10 nucleotides, andpreferably at most one mismatch out of 20. Alternatively, the antisenseoligomers employed have at least 90% sequence homology, and preferablyat least 95% sequence homology, with the exemplary targeting sequencesas designated herein. For purposes of complementary binding to an RNAtarget, and as discussed below, a guanine base may be complementary toeither an adenine or uracil RNA base.

An oligonucleotide analog “specifically hybridizes” to a targetpolynucleotide if the oligomer hybridizes to the target underphysiological conditions, with a T_(m) substantially greater than 45°C., preferably at least 50° C., and typically 60° C.-80° C. or higher.Such hybridization preferably corresponds to stringent hybridizationconditions. At a given ionic strength and pH, the T_(m) is thetemperature at which 50% of a target sequence hybridizes to acomplementary polynucleotide. Again, such hybridization may occur with“near” or “substantial” complementary of the antisense oligomer to thetarget sequence, as well as with exact complementarity.

A “nuclease-resistant” oligomeric molecule (oligomer) refers to onewhose backbone is substantially resistant to nuclease cleavage, innon-hybridized or hybridized form; by common extracellular andintracellular nucleases in the body; that is, the oligomer shows littleor no nuclease cleavage under normal nuclease conditions in the body towhich the oligomer is exposed.

A “heteroduplex” refers to a duplex between an oligonculeotide analogand the complementary portion of a target RNA. A “nuclease-resistantheteroduplex” refers to a heteroduplex formed by the binding of anantisense oligomer to its complementary target, such that theheteroduplex is substantially resistant to in vivo degradation byintracellular and extracellular nucleases, such as RNAse H, which arecapable of cutting double-stranded RNA/RNA or RNA/DNA complexes.

“Treatment” of an individual or a cell is any type of interventionprovided as a means to alter the natural course of the individual orcell. Treatment includes, but is not limited to, administration of e.g.,a pharmaceutical composition, and may be performed eitherprophylactically, or subsequent to the initiation of a pathologic eventor contact with an etiologic agent. The related term “improvedtherapeutic outcome” relative to a patient diagnosed as infected with aparticular virus, refers to a slowing or diminution in the growth ofvirus, or viral load, or detectable symptoms associated with infectionby that particular virus.

As used herein the term “compound” includes any reagent which is testedusing the assays of the invention to determine whether it modulatessplice site modulation, e.g., oligonucleotide reagent-mediated splicingmodulation. More than one compound, e.g., a plurality of compounds, canbe tested at the same time for their ability to modulate splicing in ascreening assay.

In one embodiment, test compounds comprise any selection of the groupconsisting of a small molecule (e.g., an organic molecule having amolecular weight of about 1000 Da or less), a peptide, a polynucleotide,an antibody or biologically active portion thereof, a peptidomimetic,and a non-peptide oligomer.

A gene “involved” in a disorder includes a gene, the normal or aberrantexpression or function of which effects or causes a disease or disorderor at least one symptom of said disease or disorder.

Various methodologies of the invention include a step that involvescomparing a value, level, feature, characteristic, property, etc. to a“suitable control”, referred to interchangeably herein as an“appropriate control”. A “suitable control” or “appropriate control” isany control or standard familiar to one of ordinary skill in the artuseful for comparison purposes. In one embodiment, a “suitable control”or “appropriate control” is a value, level, feature, characteristic,property, etc. determined prior to performing an oligonucleotide reagentmethodology, as described herein. For example, a transcription rate,mRNA level and/or splicing pattern, translation rate, protein level,biological activity, cellular characteristic or property, genotype,phenotype, etc. can be determined prior to introducing anoligonucleotide reagent (e.g., an oligonucleotide, compound, etc., thatalters splicing of target pre-mRNA in a sequence-specific manner) of theinvention into a cell or organism. In another embodiment, a “suitablecontrol” or “appropriate control” is a value, level, feature,characteristic, property, etc. determined in a cell or organism, e.g., acontrol or normal cell or organism, exhibiting, for example, normaltraits. In yet another embodiment, a “suitable control” or “appropriatecontrol” is a predefined value, level, feature, characteristic,property, etc.

Various aspects of the invention are described in further detail in thefollowing subsections.

I. Oligonucleotide Reagents and Splice Site Alteration

The present invention is directed to oligonucleotide reagents, e.g.,antisense oligonucleotides, suitable for use in blocking a domain of atarget RNA (in exemplary embodiments, a pre-mRNA is blocked, therebymodulating splice site selection of the mRNA splicing machinery) both invitro and in vivo. In vivo methodologies are useful for both generalsplice site modulatory purposes as well as in therapeutic applicationsin which blocking of a target mRNA domain (e.g., enhancement of splicesite selection via oligonucleotide reagent-mediated inhibition of asplice site inhibitor domain) is desirable. Oligonucleotide reagents ofthe invention are of any size and/or chemical composition sufficient toblock a target RNA (e.g., pre-mRNA), in particular exemplaryembodiments, the reagent is of any size and/or chemical compositionsufficient to inhibit the intron 7 splice silencing domain of SMN2. Inexemplary embodiments, the oligonucleotide reagents of the invention areoligonucleotides of between about 5-300 nucleotides (or modifiednucleotides), preferably between about 10-100 nucleotides (or modifiednucleotides; e.g., ribonucleotides or modified ribonucleotides), forexample, between about 15-35, e.g., about 15-20, 20-25, 25-30, 30-35(31, 32, 33, 34, 35), or 35-40 nucleotides (or modified nucleotides;e.g., ribonucleotides or modified ribonucleotides). Oligonucleotidereagents are preferably sufficiently-complementary to target RNAsequences, in particular embodiments, the short intron 7 novel domainsequence of the SMN2 pre-mRNA. In exemplary embodiments of theinvention, oligonucleotide reagents comprise oligonucleotides thatcontain phosphorothioate and 2′-O-methyl (e.g., 2′-O-methylcytidine,2′-O-methylpseudouridine, 2′-O-methylguanosine, 2′-O-methyluridine,2′-O-methyladenosine, 2′-O-methyl) modifications. Many other forms ofoligonucleotide modification may be used to generate oligonucleotidereagents of the instant invention, including, for example, lockednucleic acids (oligonucleotides comprising at least one2′-C,4′-C-oxy-methylene-linked bicyclic ribonucleotide monomer), withone of skill in the art recognizing other modifications capable ofrendering an oligonucleotide reagent effective for inducing inclusion ofa target exon during RNA splicing (especially as relates to in vivostability of the oligonucleotide reagents--refer to “Modifications”section below).

An oligonucleotide reagent can be, for example, about 5, 10, 15, 20, 25,30, 35, 40, 45, or 50 or more nucleotides in length. An oligonucleotidereagent of the invention can be constructed using chemical synthesis andenzymatic ligation reactions using procedures known in the art. Forexample, an oligonucleotide reagent (e.g., an antisense oligonucleotide)can be chemically synthesized using naturally occurring nucleotides orvariously modified nucleotides designed to increase the biologicalstability of the molecules or to increase the physical stability of theduplex formed between the antisense and sense nucleic acids, e.g.,phosphorothioate derivatives and acridine substituted nucleotides can beused. Examples of modified nucleotides which can be used to generate theantisense nucleic acid include 5-fluorouracil, 5-bromouracil,5-chlorouracil, 5-iodouracil, hypoxanthine, xanthine, 4-acetylcytosine,5-(carboxyhydroxylmethyl)uracil,5-carboxymethylaminomethyl-2-thiouridine,5-carboxymethylaminomethyluracil, dihydrouracil,beta-D-galactosylqueosine, inosine, N6-isopentenyladenine,1-methylguanine, 1-methylinosine, 2,2-dimethylguanine, 2-methyladenine,2-methylguanine, 3-methylcytosine, 5-methylcytosine, N6-adenine,7-methylguanine, 5-methylaminomethyluracil,5-methoxyaminomethyl-2-thiouracil, beta-D-mannosylqueosine,5′-methoxycarboxymethyluraci 1, 5-methoxyuracil,2-methylthio-N6-isopentenyladenine, uracil-5-oxyacetic acid (v),wybutoxosine, pseudouracil, queosine, 2-thiocytosine,5-methyl-2-thiouracil, 2-thiouracil, 4-thiouracil, 5-methyluracil,uracil-5-oxyacetic acid methylester, uracil-5-oxyacetic acid (v),5-methyl-2-thiouracil, 3-(3-amino-3-N-2-carboxypropyl)uracil, (acp3)w,and 2,6-diaminopurine. Alternatively, the oligonucleotide reagent can beproduced biologically using an expression vector into which a nucleicacid has been sub-cloned, e.g., in an antisense orientation (i.e., RNAtranscribed from the inserted nucleic acid will be of an antisenseorientation to a target nucleic acid of interest, described further inthe following subsection).

The oligonucleotide reagents of the invention are typically administeredto a subject or generated in situ such that they hybridize with or bindto cellular pre-mRNA and/or genomic DNA comprising an intron 7 splicesilencing sequence identified herein to thereby inhibit exclusion of anexon during splicing. The hybridization can be by conventionalnucleotide complementarity to form a stable duplex, or, for example, inthe case of an oligonucleotide reagent which binds to DNA duplexes,through specific interactions in the major groove of the double helix.Examples of a route of administration of oligonucleotide reagents of theinvention include direct injection at a tissue site or infusion of theantisense nucleic acid into an appropriately-associated body fluid,e.g., cerebrospinal fluid. Alternatively, oligonucleotide reagents canbe modified to target selected cells and then administered systemically.For example, for systemic administration, oligonucleotide reagents canbe modified such that they specifically bind to receptors or antigensexpressed on a selected cell surface, e.g., by linking theoligonucleotide reagents to peptides or antibodies which bind to cellsurface receptors or antigens. The oligonucleotide reagents can also bedelivered to cells using the vectors described herein. To achievesufficient intracellular concentrations of the oligonucleotide reagents,vector constructs in which the oligonucleotide reagent is placed underthe control of a strong pol II or pol III promoter are preferred.

An oligonucleotide reagent of the invention can be an a-anomeric nucleicacid molecule. An α-anomeric nucleic acid molecule forms specificdouble-stranded hybrids with complementary RNA in which, contrary to theusual α-units, the strands run parallel to each other (Gaultier et al.,1987, Nucleic Acids Res. 15:6625-6641). The oligonucleotide reagent canalso comprise a 2′-o-methylribonucleotide (Inoue et al., 1987, NucleicAcids Res. 15:6131-6148) or a chimeric RNA-DNA analogue (Inoue et al.,1987, FEBS Lett. 215:327-330).

In various embodiments, the oligonucleotide reagents of the inventioncan be modified at the base moiety, sugar moiety or phosphate backboneto improve, e.g., the stability, hybridization, or solubility of themolecule. For example, the deoxyribose phosphate backbone of the nucleicacid molecules can be modified to generate peptide nucleic acidmolecules (see Hyrup et al., 1996, Bioorganic & Medicinal Chemistry4(1): 5-23). As used herein, the terms “peptide nucleic acids” or “PNAs”refer to nucleic acid mimics, e.g., DNA mimics, in which the deoxyribosephosphate backbone is replaced by a pseudopeptide backbone and only thefour natural nucleobases are retained. The neutral backbone of PNAs hasbeen shown to allow for specific hybridization to DNA and RNA underconditions of low ionic strength. The synthesis of PNA oligomers can beperformed using standard solid phase peptide synthesis protocols asdescribed in Hyrup et al. (1996), supra; Perry-O'Keefe et al. (1996)Proc. Natl. Acad. Sci. USA 93:14670-675.

PNAs can be used in therapeutic and diagnostic applications. Forexample, PNAs can be used as antisense or antigene agents forsequence-specific modulation of gene expression by, e.g., inducingtranscription or translation arrest or inhibiting replication. PNAs canalso be used, e.g., in the analysis of single base pair mutations in agene by, e.g., PNA directed PCR clamping; as artificial restrictionenzymes when used in combination with other enzymes, e.g., S1 nucleases(Hyrup (1996), supra; or as probes or primers for DNA sequence andhybridization (Hyrup, 1996, supra; Perry-O'Keefe et al., 1996, Proc.Natl. Acad. Sci. USA 93:14670-675). In certain embodiments of theinstant invention, PNAs can also be generated to target the criticalintron 7 sequences identified herein.

In another embodiment, PNAs can be modified, e.g., to enhance theirstability or cellular uptake, by attaching lipophilic or other helpergroups to PNA, by the formation of PNA-DNA chimeras, or by the use ofliposomes or other techniques of drug delivery known in the art. Forexample, PNA-DNA chimeras can be generated which can combine theadvantageous properties of PNA and DNA. Such chimeras allow DNArecognition enzymes, e.g., RNASE H and DNA polymerases, to interact withthe DNA portion while the PNA portion would provide high bindingaffinity and specificity. PNA-DNA chimeras can be linked using linkersof appropriate lengths selected in terms of base stacking, number ofbonds between the nucleobases, and orientation (Hyrup, 1996, supra). Thesynthesis of PNA-DNA chimeras can be performed as described in Hyrup(1996), supra, and Finn et al. (1996) Nucleic Acids Res. 24(17):3357-63.For example, a DNA chain can be synthesized on a solid support usingstandard phosphoramidite coupling chemistry and modified nucleosideanalogs. Compounds such as 5′-(4-methoxytrityl)amino-5′-deoxy-thymidinephosphoramidite can be used as a link between the PNA and the 5′ end ofDNA (Mag et al., 1989, Nucleic Acids Res. 17:5973-88). PNA monomers arethen coupled in a step-wise manner to produce a chimeric molecule with a5′ PNA segment and a 3′ DNA segment (Finn et al., 1996, Nucleic AcidsRes. 24(17): 3357-63). Alternatively, chimeric molecules can besynthesized with a 5′ DNA segment and a 3′ PNA segment (Peterser et al.,1975, Bioorganic Med. Chem. Lett. 5: 1119-11124).

In certain embodiments of the present invention, a PNA compound thatbinds to a short intron 7 SMN2 target sequence can be generatedadditionally to contain one or more charged groups. Such tethering ofcharged groups to anti-intron 7 SMN2 target compounds can improve thedelivery and/or activity of the anti- intron 7 SMN2 compounds of theinvention, or also can be used to minimize non-specific effectspotentially associated with alternative other formulations of theoligonucleotide reagents of the instant invention. In one embodiment,the oligonucleotide reagents of the invention can be generated asphosphono-PNA molecules (pPNAs), wherein one or more phosphate groupsare attached to and/or incorporated into the backbone of theoligonucleotide reagent (refer to Efimov, V., et al. 2003 Nucleosides,Nucleotides & Nucleic Acids 22(5-8): 593-599, incorporated in itsentirety herein by reference).

In further embodiments, the oligonucleotide reagents of the inventioncan be generated as gripNA™ compounds. GripNA™ molecules are a form ofnegatively charged PNA, which exhibit greater sequence specificitycompared to conventional oligonucleotide reagents (e.g., antisense/genesilencing reagents) (refer to “Custom gripNA™ Synthesis Service”handbook (version B2, available through ActiveMotif atwww.activemotif.com) and to U.S. Pat. No. 6,962,906, incorporated in itsentirety herein by reference).

In additional embodiments, the oligonucleotide reagents of the inventioncan be generated as steroid-conjugated PNAs. For example, a steroid(e.g., glucocorticoid) dexamethasone can be linked to a PNA of theinstant invention, as described in Rebuffat, A. G., et al. (FASEB J.2002 16(11): 1426-8, the entire contents of which are incorporatedherein by reference). The oligonucleotide reagents of the invention canalso be produced as tricycle-DNA molecules ((tc)-DNAs) that are splicesite-targeted, as described in Ittig, D., et al. (Nucleic Acids Res.2004 32(1):346-53, the entire contents of which are incorporated hereinby reference).

The oligonucleotide reagents of the invention can also be formulated asmorpholino oligonucleotides. In such embodiments, the riboside moiety ofeach subunit of an oligonucleotide of the oligonucleotide reagent isconverted to a morpholine moiety (morpholine=C₄H.₉NO; refer to Heasman,J. 2002 Developmental Biology 243, 209-214, the entire contents of whichare incorporated herein by reference).

The preceding forms of modifications can improve the delivery and/oractivity of the oligonucleotide reagents of the invention, or also canbe used to minimize non-specific effects potentially associated withalternative formulations of the oligonucleotide reagents of the instantinvention.

In other embodiments, the oligonucleotide can include other appendedgroups such as peptides (e.g., for targeting host cell receptors invivo), or agents facilitating transport across the cell membrane (see,e.g., Letsinger et al., 1989, Proc. Natl. Acad. Sci. USA 86:6553-6556;Lemaitre et al., 1987, Proc. Natl. Acad. Sci. USA 84:648-652; PCTPublication No. WO 88/09810) or the blood-brain barrier (see, e.g., PCTPublication No. WO 89/10134). In addition, oligonucleotides can bemodified with hybridization-triggered cleavage agents (see, e.g., Krolet al., 1988, Bio/Techniques 6:958-976) or intercalating agents (see,e.g., Zon, 1988, Pharm. Res. 5:539-549). To this end, theoligonucleotide can be conjugated to another molecule, e.g., a peptide,hybridization triggered cross-linking agent, transport agent,hybridization-triggered cleavage agent, etc.

The invention also includes molecular beacon nucleic acid moleculeshaving at least one region which is complementary to a nucleic acidmolecule of the invention, such that the molecular beacon is useful forquantitating the presence of the nucleic acid molecule of the inventionin a sample. A “molecular beacon” nucleic acid is a nucleic acidmolecule comprising a pair of complementary regions and having afluorophore and a fluorescent quencher associated therewith. Thefluorophore and quencher are associated with different portions of thenucleic acid in such an orientation that when the complementary regionsare annealed with one another, fluorescence of the fluorophore isquenched by the quencher. When the complementary regions of the nucleicacid molecules are not annealed with one another, fluorescence of thefluorophore is quenched to a lesser degree. Molecular beacon nucleicacid molecules are described, for example, in U.S. Pat. No. 5,876,930.

In another embodiment, oligonucleotide reagents of the invention containsequences which naturally flank the small intron 7 target sequence(i.e., sequences located at the 5′ and 3′ ends of the intron 7 criticalsequence) in the genomic DNA of an organism. In various embodiments, theisolated oligonucleotide agent can contain about 100 kB, 50 kB, 25 kB,15 kB, 10 kB, 5 kB, 4 kB, 3 kB, 2 kB, 1 kB, 0.5 kB or 0.1 kB ofnucleotide sequences which naturally flank the intron 7 critical targetsequence in genomic DNA of the targeted cell. Moreover, anoligonucleotide reagent can be substantially free of other cellularmaterial or culture medium when produced by recombinant techniques, orsubstantially free of chemical precursors or other chemicals whenchemically synthesized.

The target RNA (e.g., pre-mRNA) blocking reaction guided byoligonucleotide reagents of the invention is highly sequence specific.In general, oligonucleotide reagents containing nucleotide sequencesperfectly complementary to a portion of the target RNA are preferred forblocking of the target RNA. However, 100% sequence complementaritybetween the oligonucleotide reagent and the target RNA is not requiredto practice the present invention. Thus, the invention may toleratesequence variations that might be expected due to genetic mutation,strain polymorphism, or evolutionary divergence. For example,oligonucleotide reagent sequences with insertions, deletions, and singlepoint mutations relative to the target sequence may also be effectivefor inhibition. Alternatively, oligonucleotide reagent sequences withnucleotide analog substitutions or insertions can be effective forblocking.

Greater than 70% sequence identity (or complementarity), e.g., 70%, 71%,72%, 73%, 74%, 75%, 76%, 77%, 78%, 79%, 80%, 81%, 82%, 83%, 84%, 85%,86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% oreven 100% sequence identity, between the oligonucleotide reagent and thetarget RNA, e.g., target pre-mRNA, is preferred.

In addition, variants of the short target intron 7 sequence which retainthe function of same can be used in the methods of the invention. Forexample, a series of mutants of may be and tested for their ability toinhibit alternative splicing. In one embodiment, such variant sequencesare at least about 95% identical in sequence to SEQ ID NO:3 or 4 overthe entire length of the same. In another embodiment, such variantsequences are at least about 90% identical in the sequence over theentire length of the same.

Sequence identity, including determination of sequence complementarityfor nucleic acid sequences, may be determined by sequence comparison andalignment algorithms known in the art. To determine the percent identityof two nucleic acid sequences (or of two amino acid sequences), thesequences are aligned for optimal comparison purposes (e.g., gaps can beintroduced in the first sequence or second sequence for optimalalignment). The nucleotides (or amino acid residues) at correspondingnucleotide (or amino acid) positions are then compared. When a positionin the first sequence is occupied by the same residue as thecorresponding position in the second sequence, then the molecules areidentical at that position. The percent identity between the twosequences is a function of the number of identical positions shared bythe sequences (i.e., % homology=# of identical positions/total # ofpositions×100), optionally penalizing the score for the number of gapsintroduced and/or length of gaps introduced.

The comparison of sequences and determination of percent identitybetween two sequences can be accomplished using a mathematicalalgorithm. In one embodiment, the alignment generated over a certainportion of the sequence aligned having sufficient identity but not overportions having low degree of identity (i.e., a local alignment). Apreferred, non-limiting example of a local alignment algorithm utilizedfor the comparison of sequences is the algorithm of Karlin and Altschul(1990) Proc. Natl. Acad. Sci. USA 87:2264-68, modified as in Karlin andAltschul (1993) Proc. Natl. Acad. Sci. USA 90:5873-77. Such an algorithmis incorporated into the BLAST programs (version 2.0) of Altschul, etal. (1990) J. Mol. Biol. 215:403-10.

In another embodiment, the alignment is optimized by introducingappropriate gaps and percent identity is determined over the length ofthe aligned sequences (i.e., a gapped alignment). To obtain gappedalignments for comparison purposes, Gapped BLAST can be utilized asdescribed in Altschul et al., (1997) Nucleic Acids Res.25(17):3389-3402. In another embodiment, the alignment is optimized byintroducing appropriate gaps and percent identity is determined over theentire length of the sequences aligned (i.e., a global alignment). Apreferred, non-limiting example of a mathematical algorithm utilized forthe global comparison of sequences is the algorithm of Myers and Miller,CABIOS (1989). Such an algorithm is incorporated into the ALIGN program(version 2.0) which is part of the GCG sequence alignment softwarepackage. When utilizing the ALIGN program for comparing amino acidsequences, a PAM 120 weight residue table, a gap length penalty of 12,and a gap penalty of 4 can be used.

Alternatively, the oligonucleotide reagent may be defined functionallyas a nucleotide sequence (or oligonucleotide sequence) a portion ofwhich is capable of hybridizing with the target RNA (e.g., 400 mM NaCl,40 mM PIPES pH 6.4, 1 mM EDTA, 50° C. or 70° C. hybridization for 12-16hours; followed by washing). Additional preferred hybridizationconditions include hybridization at 70° C. in 1×SSC or 50° C. in 1×SSC,50% formamide followed by washing at 70° C. in 0.3×SSC or hybridizationat 70° C. in 4×SSC or 50° C. in 4×SSC, 50% formamide followed by washingat 67° C. in 1×SSC. The hybridization temperature for hybridsanticipated to be less than 50 base pairs in length should be 5-10° C.less than the melting temperature (Tm) of the hybrid, where Tm isdetermined according to the following equations. For hybrids less than18 base pairs in length, Tm° C.)=2(# of A+T bases)+4(# of G+C bases).For hybrids between 18 and 49 base pairs in length, Tm°C.)=81.5+16.6(log 10[Na+])+0.41(% G+C)−(600/N), where N is the number ofbases in the hybrid, and [Na+] is the concentration of sodium ions inthe hybridization buffer ([Na+] for 1×SSC=0.165 M). Additional examplesof stringency conditions for polynucleotide hybridization are providedin Sambrook, J., E. F. Fritsch, and T. Maniatis, 1989, MolecularCloning: A Laboratory Manual, Cold Spring Harbor Laboratory Press, ColdSpring Harbor, N.Y., chapters 9 and 11, and Current Protocols inMolecular Biology, 1995, F. M. Ausubel et al., eds., John Wiley & Sons,Inc., sections 2.10 and 6.3-6.4, incorporated herein by reference. Thelength of the identical nucleotide sequences may be at least about 10,12, 15, 17, 20, 22, 25, 27, 30, 32, 35, 37, 40, 42, 45, 47 or 50 bases.

Modifications

In a preferred aspect, the oligonucleotide reagents (e.g,oligoribonucleotides, such as anti-short intron 7 targetoligoribonucleotides) of the present invention are modified to improvestability in serum or growth medium for cell cultures, or otherwise toenhance stability during delivery to SMA subjects and/or cell cultures.In order to enhance the stability, the 3′-residues may be stabilizedagainst degradation, e.g., they may be selected such that they consistof purine nucleotides, particularly adenosine or guanosine nucleotides.Alternatively, substitution of pyrimidine nucleotides by modifiedanalogues, e.g., substitution of uridine by 2′-deoxythymidine can betolerated without affecting the efficiency of oligonucleotidereagent-induced modulation of splice site selection. For example, theabsence of a 2′ hydroxyl may significantly enhance the nucleaseresistance of the oligonucleotide reagents in tissue culture medium.

In an especially preferred embodiment of the present invention theoligonucleotide reagents, e.g., anti-short intron 7 antisense molecules,may contain at least one modified nucleotide analogue. The nucleotideanalogues may be located at positions where the target-specificactivity, e.g., the splice site selection modulating activity is notsubstantially effected, e.g., in a region at the 5′-end and/or the3′-end of the oligonucleotide (in preferred embodiments,oligoribonucleotide) molecule. Particularly, the ends may be stabilizedby incorporating modified nucleotide analogues.

Preferred nucleotide analogues include sugar- and/or backbone-modifiedribonucleotides (i.e., include modifications to the phosphate-sugarbackbone). For example, the phosphodiester linkages of natural RNA maybe modified to include at least one of a nitrogen or sulfur heteroatom.In preferred backbone-modified ribonucleotides the phosphoester groupconnecting to adjacent ribonucleotides is replaced by a modified group,e.g., of phosphothioate group. In preferred sugar-modifiedribonucleotides, the 2′ OH-group is replaced by a group selected from H,OR, R, halo, SH, SR, NH₂, NHR, NR₂ or ON, wherein R is C₁-C₆ alkyl,alkenyl or alkynyl and halo is F, Cl, Br or I.

Also preferred are nucleobase-modified ribonucleotides, i.e.,ribonucleotides, containing at least one non-naturally occurringnucleobase instead of a naturally occurring nucleobase. Bases may bemodified to block the activity of adenosine deaminase. Exemplarymodified nucleobases include, but are not limited to, uridine and/orcytidine modified at the 5-position, e.g., 5-(2-amino)propyl uridine,5-bromo uridine; adenosine and/or guanosines modified at the 8 position,e.g., 8-bromo guanosine; deaza nucleotides, e.g., 7-deaza-adenosine; O-and N-alkylated nucleotides, e.g., N6-methyl adenosine are suitable. Itshould be noted that the above modifications may be combined.Oligonucleotide reagents of the invention also may be modified withchemical moieties (e.g., cholesterol) that improve the in vivopharmacological properties of the oligonucleotide reagents.

A further preferred oligonucleotide modification includes Locked NucleicAcids (LNAs) in which the 2′-hydroxyl group is linked to the 3′ or 4′carbon atom of the sugar ring thereby forming a bicyclic sugar moiety.The linkage is preferably a methelyne (—CH₂—)_(n) group bridging the 2′oxygen atom and the 4′ carbon atom wherein n is 1 or 2. LNAs andpreparation thereof are described in WO 98/39352 and WO 99/14226, theentire contents of which are incorporated by reference herein.

Within the oligonucleotide reagents (e.g., oligoribonucleotides) of theinvention, as few as one and as many as all nucleotides of theoligonucleotide can be modified. For example, a 20-mer oligonucleotidereagent (e.g., oligoribonucleotide) of the invention may contain 1, 2,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20modified nucleotides. In preferred embodiments, the modifiedoligonucleotides (e.g., oligoribonucleotides) of the invention willcontain as few modified nucleotides as are necessary to achieve adesired level of in vivo stability and/or bioaccessibility whilemaintaining cost effectiveness.

RNA molecules and oligonucleotide reagents may be produced enzymaticallyor by partial/total organic synthesis, any modified ribonucleotide canbe introduced by in vitro enzymatic or organic synthesis. In oneembodiment, an RNA molecule, e.g., oligonucleotide reagent, is preparedchemically. Methods of synthesizing RNA and DNA molecules are known inthe art, in particular, the chemical synthesis methods as described inVerma and Eckstein (1998) Annul Rev. Biochem. 67:99-134. RNA can bepurified from a mixture by extraction with a solvent or resin,precipitation, electrophoresis, chromatography, or a combinationthereof. Alternatively, the RNA may be used with no or a minimum ofpurification to avoid losses due to sample processing. Alternatively,the RNA molecules, e.g., oligonucleotide reagents, can also be preparedby enzymatic transcription from synthetic DNA templates or from DNAplasmids isolated from recombinant bacteria. Typically, phage RNApolymerases are used such as T7, T3 or SP6 RNA polymerase (Milligan andUhlenbeck (1989) Methods Enzymol. 180:51-62). The RNA may be dried forstorage or dissolved in an aqueous solution. The solution may containbuffers or salts to inhibit annealing, and/or promote stabilization ofthe single strands.

In preferred embodiments of the invention, the target RNA of anoligonucleotide reagent specifies the amino acid sequence of SMNprotein. As used herein, the phrase “specifies the amino acid sequence”of a SMN means that the mRNA sequence is translated into a SMN aminoacid sequence according to the rules of the genetic code.

By blocking domains within RNAs (e.g., pre-mRNAs) capable of beingtranslated into such proteins, valuable information regarding thefunction of said oligonucleotide reagent and/or proteins and therapeuticbenefits of said blocking may be obtained.

Splice forms and expression levels of surveyed RNAs and proteins may beassessed by any of a wide variety of well known methods for detectingsplice forms and/or expression of a transcribed nucleic acid or protein.Non-limiting examples of such methods include RT-PCR of spliced forms ofRNA followed by size separation of PCR products, nucleic acidhybridization methods e.g., Northern blots and/or use of nucleic acidarrays; nucleic acid amplification methods; immunological methods fordetection of proteins; protein purification methods; and proteinfunction or activity assays.

RNA expression levels can be assessed by preparing mRNA/cDNA (i.e. atranscribed polynucleotide) from a cell, tissue or organism, and byhybridizing the mRNA/cDNA with a reference polynucleotide which is acomplement of the assayed nucleic acid, or a fragment thereof. cDNA can,optionally, be amplified using any of a variety of polymerase chainreaction or in vitro transcription methods prior to hybridization withthe complementary polynucleotide; preferably, it is not amplified.Expression of one or more transcripts can also be detected usingquantitative PCR to assess the level of expression of the transcript(s).

In one embodiment, oligonucleotide reagents are synthesized either invivo, in situ, or in vitro. Endogenous RNA polymerase of the cell maymediate transcription in vivo or in situ, or cloned RNA polymerase canbe used for transcription in vivo or in vitro. For transcription from atransgene in vivo or an expression construct, a regulatory region (e.g.,promoter, enhancer, silencer, splice donor and acceptor,polyadenylation) may be used to transcribe the oligonucleotide reagent.Production of oligonucleotide reagents may be targeted by specifictranscription in an organ, tissue, or cell type; stimulation of anenvironmental condition (e.g., infection, stress, temperature, chemicalinducers); and/or engineering transcription at a developmental stage orage. A transgenic organism that expresses an oligonucleotide reagentfrom a recombinant construct may be produced by introducing theconstruct into a zygote, an embryonic stem cell, or another multipotentcell derived from the appropriate organism.

II. Methods of Introducing RNAs, Vectors, and Host Cells

An oligonucleotide reagent construct of the present invention can bedelivered to cells ex vivo or in vivo, for example, as an expressionplasmid which, when transcribed in the cell, produces RNA, which iscomplementary to at least a unique portion of the cellular pre-mRNAwhich encodes an SMN protein.

Alternatively, the oligonucleotide reagent can be an oligonucleotidewhich is generated ex vivo and which, when introduced into the cell,causes inhibition of expression by hybridizing with the pre-mRNA, mRNAand/or genomic sequences of the SMN2 gene. Such oligonucleotides arepreferably modified oligonucleotides, which are resistant to endogenousnucleases, e.g. exonucleases and/or endonucleases, and are thereforestable in vivo. Exemplary nucleic acid molecules for use as antisenseoligonucleotides are phosphoramidate, phosphothioate andmethylphosphonate analogs of oligonucleotide (see also U.S. Pat. Nos.5,176,996, 5,294,564 and 5,256,775, which are herein incorporated byreference).

Oligonucleotide sequences can be introduced into cells as is known inthe art. Transfection, electroporation, fusion, liposomes, colloidalpolymeric particles and viral and non-viral vectors as well as othermeans known in the art may be used to deliver the oligonucleotidesequences to the cell. The method of delivery selected will depend atleast on the cells to be treated and the location of the cells and willbe known to those skilled in the art. Localization can be achieved byliposomes, having specific markers on the surface for directing theliposome, by having injection directly into the tissue containing thetarget cells, by having depot associated in spatial proximity with thetarget cells, specific receptor mediated uptake, viral vectors, or thelike.

In certain embodiments, ribozymes can be used to deliver oligonucleotidereagents of the invention directed against short intron 7 targetsequences (including functional variants of the same) to a necessarysite within a given intron. Ribozyme design is an art-recognizedprocess, described, e.g., in U.S. Pat. No. 6,770,633, the entirecontents of which are incorporated by reference herein.

Physical methods of introducing nucleic acids include injection of asolution containing the RNA, bombardment by particles covered by theRNA, soaking the cell or organism in a solution of the RNA, orelectroporation of cell membranes in the presence of the RNA. A viralconstruct packaged into a viral particle would accomplish both efficientintroduction of an expression construct into the cell and transcriptionof RNA encoded by the expression construct. Other methods known in theart for introducing nucleic acids to cells may be used, such aslipid-mediated carrier transport, chemical-mediated transport, such ascalcium phosphate, and the like. Thus the RNA may be introduced alongwith components that perform one or more of the following activities:enhance RNA uptake by the cell, inhibit annealing of single strands,stabilize the single strands, or other-wise increase inhibition of thetarget gene.

As described supra and in the art, oligonucleotide reagents may bedelivered using, e.g., methods involving liposome-mediated uptake, lipidconjugates, polylysine-mediated uptake, nanoparticle-mediated uptake,and receptor-mediated endocytosis, as well as additional non-endocyticmodes of delivery, such as microinjection, permeabilization (e.g.,streptolysin-O permeabilization, anionic peptide permeabilization),electroporation, and various non-invasive non-endocytic methods ofdelivery that are known in the art (refer to Dokka and Rojanasakul,Advanced Drug Delivery Reviews 44, 35-49, incorporated in its entiretyherein by reference).

Oligonucleotide reagents may be directly introduced into the cell (i.e.,intracellularly); or introduced extracellularly into a cavity,interstitial space, into the circulation of an organism, introducedorally, or may be introduced by bathing a cell or organism in a solutioncontaining the RNA using methods known in the art for introducingnucleic acid (e.g., DNA) into cells in vivo. Vascular or extravascularcirculation, the blood or lymph system, and the cerebrospinal fluid aresites where the RNA may be introduced.

The present invention also provides vectors comprising an expressioncontrol sequence operatively linked to the oligonucleotide sequences ofthe invention. The present invention further provides host cells,selected from suitable eukaryotic and prokaryotic cells, which aretransformed with these vectors as necessary. Such transformed cellsallow the study of the function and the regulation of malignancy and thetreatment therapy of the present invention.

Vectors are known or can be constructed by those skilled in the art andshould contain all expression elements necessary to achieve the desiredtranscription of the sequences. Other beneficial characteristics canalso be contained within the vectors such as mechanisms for recovery ofthe oligonucleotides in a different form. Phagemids are a specificexample of such beneficial vectors because they can be used either asplasmids or as bacteriophage vectors. Examples of other vectors includeviruses such as bacteriophages, baculoviruses and retroviruses, DNAviruses, liposomes and other recombination vectors. The vectors can alsocontain elements for use in either prokaryotic or eukaryotic hostsystems. One of ordinary skill in the art will know which host systemsare compatible with a particular vector. The vectors can be introducedinto cells or tissues by any one of a variety of known methods withinthe art. Such methods can be found generally described in Sambrook etal., Molecular Cloning: A Laboratory Manual, Cold Springs HarborLaboratory, New York (1989, 1992), in Ausubel et al., Current Protocolsin Molecular Biology, John Wiley and Sons, Baltimore, Md. (1989), Changet al., Somatic Gene Therapy, CRC Press, Ann Arbor, Mich. (1995), Vegaet al., Gene Targeting, CRC Press, Ann Arbor, Mich. (1995), Vectors: ASurvey of Molecular Cloning Vectors and Their Uses, Butterworths, BostonMass. (1988) and Gilboa et al., BioTechniques 4:504-512 (1986) andinclude, for example, stable or transient transfection, lipofection,electroporation and infection with recombinant viral vectors. Viralvectors that have been used for gene therapy protocols include, but arenot limited to, retroviruses, other RNA viruses such as poliovirus orSindbis virus, adenovirus, adeno-associated virus, herpes viruses, SV40, vaccinia and other DNA viruses. Replication-defective murineretroviral vectors are the most widely utilized gene transfer vectors.Murine leukemia retroviruses are composed of a single strand RNAcompleted with a nuclear core protein and polymerase (pol) enzymesencased by a protein core (gag) and surrounded by a glycoproteinenvelope (env) that determines host range. The genomic structure ofretroviruses include gag, pol, and env genes enclosed at the 5′ and 3′long terminal repeats (LTRs). Retroviral vector systems exploit the factthat a minimal vector containing the 5′ and 3′ LTRs and the packagingsignal are sufficient to allow vector packaging and infection andintegration into target cells providing that the viral structuralproteins are supplied in trans in the packaging cell line.

Recombinant methods known in the art can also be used to achieveoligonucleotide reagent-induced inhibition of splicing in a targetnucleic acid. For example, vectors containing oligonucleotide reagentscan be employed to express, e.g., an antisense oligonucleotide toinhibit splicing of an exon of a targeted pre-mRNA.

Examples of Methods to Introduced Oligonucleotide Sequences into CellsEncompass Both Non-Viral and Viral Methods, as Well as In Vivo and ExVivo Methods and Include, for Example:

Direct Injection: Naked DNA can be introduced into cells in vivo bydirectly injecting the DNA into the cells (see e.g., Acsadi et al.(1991) Nature 332:815-818; Wolff et al. (1990) Science 247:1465-1468).For example; a delivery apparatus (e.g., a “gene gun”) for injecting DNAinto cells in vivo can be used. Such an apparatus is commerciallyavailable (e.g., from BioRad).

Cationic Lipids: Naked DNA can be introduced into cells in vivo bycomplexing the DNA with cationic lipids or encapsulating the DNA incationic liposomes. Examples of suitable cationic lipid formulationsinclude N-[-1-(2,3-dioleoyloxy)propyl]N,N,N-triethylammonium chloride(DOTMA) and a 1:1 molar ratio of1,2-dimyristyloxy-propyl-3-dimethylhydroxyethylammonium bromide (DMRIE)and dioleoyl phosphatidylethanolamine (DOPE) (see e.g., Logan, J. J. etal. (1995) Gene Therapy 2:38-49; San, H. et al. (1993) Human GeneTherapy 4:781-788).

Receptor-Mediated DNA Uptake: Naked DNA can also be introduced intocells in vivo by complexing the DNA to a cation, such as polylysine,which is coupled to a ligand for a cell-surface receptor (see forexample Wu, G. and Wu, C. H. (1988) J. Biol. Chem. 263:14621; Wilson etal. (1992) J. Biol. Chem. 267:963-967; and U.S. Pat. No. 5,166,320).Binding of the DNA-ligand complex to the receptor facilitates uptake ofthe DNA by receptor-mediated endocytosis. A DNA-ligand complex linked toadenovirus capsids which naturally disrupt endosomes, thereby releasingmaterial into the cytoplasm can be used to avoid degradation of thecomplex by intracellular lysosomes (see for example Curiel et al. (1991)Proc. Natl. Acad. Sci. USA 88:8850; Cristiano et al. (1993) Proc. Natl.Acad. Sci. USA 90:2122-2126). Carrier mediated gene transfer may alsoinvolve the use of lipid-based compounds which are not liposomes. Forexample, lipofectins and cytofectins are lipid-based positive ions thatbind to negatively charged DNA and form a complex that can ferry the DNAacross a cell membrane. Another method of carrier mediated gene transferinvolves receptor-based endocytosis. In this method, a ligand (specificto a cell surface receptor) is made to form a complex with a gene ofinterest and then injected into the bloodstream. Target cells that havethe cell surface receptor will specifically bind the ligand andtransport the ligand-DNA complex into the cell.

Retroviruses: Defective retroviruses are well characterized for use ingene transfer for gene therapy purposes (for a review see Miller, A. D.(1990) Blood 76:271). A recombinant retrovirus can be constructed havinga nucleotide sequences of interest incorporated into the retroviralgenome. Additionally, portions of the retroviral genome can be removedto render the retrovirus replication defective. The replicationdefective retrovirus is then packaged into virions which can be used toinfect a target cell through the use of a helper virus by standardtechniques. Protocols for producing recombinant retroviruses and forinfecting cells in vitro or in vivo with such viruses can be found inCurrent Protocols in Molecular Biology, Ausubel, F. M. et al. (eds.)Greene Publishing Associates, (1989), Sections 9.10-9.14 and otherstandard laboratory manuals. Examples of suitable retroviruses includepLJ, pZIP, pWE and pEM which are well known to those skilled in the art.Examples of suitable packaging virus lines include ΨCrip, ΨCre, Ψ2 andΨAm. Retroviruses have been used to introduce a variety of genes intomany different cell types, including epithelial cells, endothelialcells, lymphocytes, myoblasts, hepatocytes, bone marrow cells, in vitroand/or in vivo (see for example Eglitis, et al. (1985) Science230:1395-1398; Danos and Mulligan (1988) Proc. Natl. Acad. Sci. USA85:6460-6464; Wilson et al. (1988) Proc. Natl. Acad. Sci. USA85:3014-3018; Armentano et al. (1990) Proc. Natl. Acad. Sci. USA87:6141-6145; Huber et al. (1991) Proc. Natl. Acad. Sci. USA88:8039-8043; Ferry et al. (1991) Proc. Natl. Acad. Sci. USA88:8377-8381; Chowdhury et al. (1991) Science 254:1802-1805; vanBeusechem et al. (1992) Proc. Natl. Acad. Sci. USA 89:7640-7644; Kay etal. (1992) Human Gene Therapy 3:641-647; Dai et al. (1992) Proc. Natl.Acad. Sci. USA 89:10892-10895; Hwu et al. (1993) J. Immunol.150:4104-4115; U.S. Pat. No. 4,868,116; U.S. Pat. No. 4,980,286; PCTApplication WO 89/07136; PCT Application WO 89/02468; PCT Application WO89/05345; and PCT Application WO 92/07573). Retroviral vectors requiretarget cell division in order for the retroviral genome (and foreignnucleic acid inserted into it) to be integrated into the host genome tostably introduce nucleic acid into the cell. Thus, it may be necessaryto stimulate replication of the target cell.

Adenoviruses: The genome of an adenovirus can be manipulated such thatit encodes and expresses a gene product of interest but is inactivatedin terms of its ability to replicate in a normal lytic viral life cycle.See for example Berkner et al. (1988) BioTechniques 6:616; Rosenfeld etal. (1991) Science 252:431-434; and Rosenfeld et al. (1992) Cell68:143-155. Suitable adenoviral vectors derived from the adenovirusstrain Ad type 5 d1324 or other strains of adenovirus (e.g., Ad2, Ad3,Ad7 etc.) are well known to those skilled in the art. Recombinantadenoviruses are advantageous in that they do not require dividing cellsto be effective gene delivery vehicles and can be used to infect a widevariety of cell types, including airway epithelium (Rosenfeld et al.(1992) cited supra), endothelial cells (Lemarchand et al. (1992) Proc.Natl. Acad. Sci. USA 89:6482-6486), hepatocytes (Herz and Gerard (1993)Proc. Natl. Acad. Sci. USA 90:2812-2816) and muscle cells (Quantin etal. (1992) Proc. Natl. Acad. Sci. USA 89:2581-2584). Additionally,introduced adenoviral DNA (and foreign DNA contained therein) is notintegrated into the genome of a host cell but remains episomal, therebyavoiding potential problems that can occur as a result of insertionalmutagenesis in situations where introduced DNA becomes integrated intothe host genome (e.g., retroviral DNA). Moreover, the carrying capacityof the adenoviral genome for foreign DNA is large (up to 8 kilobases)relative to other gene delivery vectors (Berkner et al. cited supra;Haj-Ahmand and Graham (1986) J. Virol. 57:267). Mostreplication-defective adenoviral vectors currently in use are deletedfor all or parts of the viral E1 and E3 genes but retain as much as 80%of the adenoviral genetic material.

Adeno-Associated Viruses: Adeno-associated virus (AAV) is a naturallyoccurring defective virus that requires another virus, such as anadenovirus or a herpes virus, as a helper virus for efficientreplication and a productive life cycle. (For a review see Muzyczka etal. Curr. Topics in Micro. and Immunol. (1992) 158:97-129). It is alsoone of the few viruses that may integrate its DNA into non-dividingcells, and exhibits a high frequency of stable integration (see forexample Flotte et al. (1992) Am. J. Respir. Cell. Mol. Biol. 7:349-356;Samulski et al. (1989) J. Virol. 63:3822-3828; and McLaughlin et al.(1989) J. Virol. 62:1963-1973). Vectors containing as little as 300 basepairs of AAV can be packaged and can integrate. Space for exogenous DNAis limited to about 4.5 kb. An AAV vector such as that described inTratschin et al. (1985) Mol. Cell. Biol. 5:3251-3260 can be used tointroduce DNA into cells. A variety of nucleic acids have beenintroduced into different cell types using AAV vectors (see for exampleHermonat et al. (1984) Proc. Natl. Acad. Sci. USA 81:6466-6470;Tratschin et al. (1985) Mol. Cell. Biol. 4:2072-2081; Wondisford et al:(1988) Mol. Endocrinol. 2:32-39; Tratschin et al. (1984) J. Virol.51:611-619; and Flotte et al. (1993) J. Biol. Chem. 268:3781-3790).

The efficacy of a particular expression vector system and method ofintroducing nucleic acid into a cell can be assessed by standardapproaches routinely used in the art. For example, DNA introduced into acell can be detected by a filter hybridization technique (e.g., Southernblotting) and RNA produced by transcription of introduced DNA can bedetected, for example, by Northern blotting, RNase protection or reversetranscriptase-polymerase chain reaction (RT-PCR). The gene product canbe detected by an appropriate assay, for example by immunologicaldetection of a produced protein, such as with a specific antibody, or bya functional assay to detect a functional activity of the gene product.

In a preferred embodiment, a retroviral expression vector encoding anoligonucleotide of the invention is used in vivo, to thereby inhibit theactivity of the short target intron 7 splice inhibiting domain of SMN2,and thus promote SMN2 exon 7 inclusion in vivo. Such retroviral vectorscan be prepared according to standard methods known in the art.

A modulatory agent, such as a chemical compound, can be administered toa subject as a pharmaceutical composition. Such compositions typicallycomprise the modulatory agent and a pharmaceutically acceptable carrier.As used herein the term “pharmaceutically acceptable carrier” isintended to include any and all solvents, dispersion media, coatings,antibacterial and antifungal agents, isotonic and absorption delayingagents, and the like, compatible with pharmaceutical administration. Theuse of such media and agents for pharmaceutically active substances iswell known in the art. Except insofar as any conventional media or agentis incompatible with the active compound, use thereof in thecompositions is contemplated. Supplementary active compounds can also beincorporated into the compositions. Pharmaceutical compositions can beprepared as described herein.

Cells targeted or used in the methods of the instant invention arepreferably mammalian cells, in particular, human cells. Cells may befrom the germ line or somatic, totipotent or pluripotent, dividing ornon-dividing, parenchyma or epithelium, immortalized or transformed, orthe like. The cell may be a stem cell or a differentiated cell. Celltypes that are differentiated include adipocytes, fibroblasts, myocytes,cardiomyocytes, endothelium, neurons, glia, blood cells, megakaryocytes,lymphocytes, macrophages, neutrophils, eosinophils, basophils, mastcells, leukocytes, granulocytes, keratinocytes, chondrocytes,osteoblasts, osteoclasts, hepatocytes, and cells of the endocrine orexocrine glands. Neurons and muscle cells (e.g., myocytes, myoblasts,myotubes, myofibers, and the like) are preferred target cells of theinvention.

Depending on the particular target gene and the dose of oligonucleotidereagent material delivered, this process may modulate function of thetarget gene. In exemplary embodiments of the instant invention, exon7-containing SMN protein production is enhanced in a treated cell, cellextract, organism or patient, with an enhancement of exon 7-containingSMN protein levels of at least about 1.1-, 1.2-, 1.5-, 2-, 3-, 4-, 5-,7-, 10-, 20-, 100-fold and higher values being exemplary. Enhancement ofgene expression refers to the presence (or observable increase) in thelevel of protein and/or mRNA product from a target RNA. Specificityrefers to the ability to act on the target RNA without manifest effectson other genes of the cell. The consequences of modulation of the targetRNA can be confirmed by examination of the outward properties of thecell or organism (as presented below in the examples) or by biochemicaltechniques such as RNA solution hybridization, nuclease protection,Northern hybridization, reverse transcription, gene expressionmonitoring with a microarray, antibody binding, enzyme linkedimmunosorbent assay (ELISA), Western blotting, radioimmunoassay (RIA),other immunoassays, and fluorescence activated cell analysis (FACS).

For oligonucleotide reagent-mediated modulation of an RNA in a cell lineor whole organism, gene expression is conveniently assayed by use of areporter or drug resistance gene whose protein product is easilyassayed. Such reporter genes include acetohydroxyacid synthase (AHAS),alkaline phosphatase (AP), beta galactosidase (LacZ), beta glucoronidase(GUS), chloramphenicol acetyltransferase (CAT), green fluorescentprotein (GFP), horseradish peroxidase (HRP), luciferase (Luc), nopalinesynthase (NOS), octopine synthase (OCS), and derivatives thereof.Multiple selectable markers are available that confer resistance toampicillin, bleomyc in, chloramphenicol, gentamycin, hygromycin,kanamycin, lincomycin, methotrexate, phosphinothricin, puromycin, andtetracyclin. Depending on the assay, quantitation of the amount of geneexpression allows one to determine a degree of modulation which isgreater than 10%, 33%, 50%, 90%, 95% or 99% as compared to a cell nottreated according to the present invention. Lower doses of injectedmaterial and longer times after administration of oligonucleotidereagents may result in modulation in a smaller fraction of cells (e.g.,at least 10%, 20%, 50%, 75%, 90%, or 95% of targeted cells).Quantitation of gene expression in a cell may show similar amounts ofmodulation at the level of accumulation of target mRNA or translation oftarget protein. As an example, the efficiency of modulation may bedetermined by assessing the amount of gene product in the cell; pre-mRNAor mRNA may be detected with a hybridization probe having a nucleotidesequence outside the region used for the oligonucleotide reagent, ortranslated polypeptide may be detected with an antibody raised againstthe polypeptide sequence of that region.

The oligonucleotide reagent may be introduced in an amount which allowsdelivery of at least one copy per cell. Higher doses (e.g., at least 5,10, 100, 500 or 1000 copies per cell) of material may yield moreeffective modulation; lower doses may also be useful for specificapplications.

III. Methods of Treatment

The present invention provides for both prophylactic and therapeuticmethods of treating a subject at risk of (or susceptible to) a disorderor having a disorder associated with aberrant or unwanted target geneexpression or activity (e.g., in exemplary embodiments, underexpressionof SMN protein). “Treatment”, or “treating” as used herein, is definedas the application or administration of a therapeutic agent (e.g., anoligonucleotide reagent (e.g., oligoribonucleotide) or vector ortransgene encoding same, a small molecule short intron 7 spliceinhibiting blocking agent, etc.) to a patient, or application oradministration of a therapeutic agent to an isolated tissue or cells(including fetal cells) from a patient, who has a disease or disorder, asymptom of disease or disorder or a predisposition toward a disease ordisorder, with the purpose to cure, heal, alleviate, relieve, alter,remedy, ameliorate, improve or affect the disease or disorder, thesymptoms of the disease or disorder, or the predisposition towarddisease.

With regards to both prophylactic and therapeutic methods of treatment,such treatments may be specifically tailored or modified, based onknowledge obtained from the field of pharmacogenomics.“Pharmacogenomics”, as used herein, refers to the application ofgenomics technologies such as gene sequencing, statistical genetics, andgene expression analysis to drugs in clinical development and on themarket. More specifically, the term refers the study of how a patient'sgenes determine his or her response to a drug (e.g., a patient's “drugresponse phenotype”, or “drug response genotype”). Thus, another aspectof the invention provides methods for tailoring an individual'sprophylactic or therapeutic treatment with either the target genemolecules of the present invention or target gene modulators accordingto that individual's drug response genotype. Pharmacogenomics allows aclinician or physician to target prophylactic or therapeutic treatmentsto patients who will most benefit from the treatment and to avoidtreatment of patients who will experience toxic drug-related sideeffects.

1. Prophylactic Methods

In one aspect, the invention provides a method for preventing in asubject, a disease or condition associated with an aberrant or unwantedtarget gene expression or activity, by administering to the subject atherapeutic agent (e.g., an oligonucleotide reagent (e.g.,oligoribonucleotide) or vector or transgene encoding same, a smallmolecule short intron 7 splice inhibiting blocking agent, etc.).Subjects at risk for a disease which is caused or contributed to byaberrant or unwanted target gene expression or activity can beidentified by, for example, any or a combination of diagnostic orprognostic assays as described herein. Administration of a prophylacticagent can occur prior to the manifestation of symptoms characteristic ofthe target gene aberrancy, such that a disease or disorder is preventedor, alternatively, delayed in its progression. Depending on the type oftarget gene aberrancy, for example, a target gene, target gene agonistor target gene antagonist agent can be used for treating the subject.The appropriate agent can be determined based on screening assaysdescribed herein.

2. Therapeutic Methods

Another aspect of the invention pertains to methods of modulating targetgene expression, protein expression or activity for therapeuticpurposes. Accordingly, in an exemplary embodiment, the modulatory methodof the invention involves contacting a cell capable of expressing targetgene with a therapeutic agent (e.g., an oligonucleotide reagent (e.g.,oligoribonucleotide) or vector or transgene encoding same, a smallmolecule short intron 7 target blocking agent, etc.) that, is specificfor the target gene or protein (e.g., is specific for the pre-mRNAencoded by said gene and/or specifying the amino acid sequence of saidprotein) such that expression or one or more of the activities of targetprotein is modulated. These modulatory methods can be performed in vitro(e.g., by culturing the cell with the agent) or, alternatively, in vivo(e.g., by administering the agent to a subject). As such, the presentinvention provides methods of treating an individual afflicted with adisease or disorder characterized by aberrant or unwanted expression oractivity of a target gene polypeptide or nucleic acid molecule.Modulation of target gene activity is desirable in situations in whichtarget gene is abnormally unregulated and/or in which altered targetgene activity is likely to have a beneficial effect.

In one embodiment, cells from a subject having spinal muscular atrophyare contacted with an oligonucleotide reagent of the invention toinhibit splicing of the SMN2 exon 7. Exemplary oligonucleotide reagentsinclude sequences complementary to the short intron 7 target sequenceand variants thereof (e.g., as shown herein). In another embodiment,cells from a subject having another disorder that would benefit frominhibition of alternative splicing are contacted with an oligonucleotidereagent of the invention. Target sequences related to the targetsequences disclosed herein are present in human intronic sequences. Forexample, there is a sequence partially homologous to the ISS-N1 sequencelocated in human CFTR (intron 10). Additional exemplary genes that canbe targeted by oligonucleotide reagents of the invention (e.g.,sequences complementary to the target sequences and variants thereof(e.g., as shown herein) include, but are not limited to, CFTR, FAS,Caspases, Diablo, NF1, Bcl2, Tau, ApoA-11, p53, Tra2, Cox-1 andSurvivin.

3. Delivery of Oligonucleotide Reagents to the Nervous System

The oligonucleotide reagents of the invention can be delivered to thenervous system of a subject by any art-recognized method. For example,peripheral blood injection of the oligonucleotide reagents of theinvention can be used to deliver said reagents to peripheral neurons viadiffusive and/or active means. Alternatively, the oligonucleotidereagents of the invention can be modified to promote crossing of theblood-brain-barrier (BBB) to achieve delivery of said reagents toneuronal cells of the central nervous system (CNS). Specific recentadvancements in oligonucleotide reagent technology and deliverystrategies have broadened the scope of oligonucleotide reagent usage forneuronal disorders (Forte, A., et al. 2005. Curr. Drug Targets 6:21-29;Jaeger, L. B., and W. A. Banks. 2005. Methods Mol. Med. 106:237-251;Vinogradov, S. V., et al. 2004. Bioconjug. Chem. 5:50-60; the precedingare incorporated herein in their entirety by reference). For example,the oligonucleotide reagents of the invention can be synthesized tocomprise phosphorothioate oligodeoxynucleotides (P-ODN) directed againstthe short intron 7 target sequence, or may be generated as peptidenucleic acid (PNA) compounds. P-ODN and PNA reagents have each beenidentified to cross the BBB (Jaeger, L. B., and W. A. Banks. 2005.Methods Mol. Med. 106:237-251). Treatment of a subject with, e.g., avasoactive agent, has also been described to promote transport acrossthe BBB (ibid.). Tethering of the oligonucleotide reagents of theinvention to agents that are actively transported across the BBB mayalso be used as a delivery mechanism.

In certain embodiments, the oligonucleotide reagents of the inventioncan be delivered by transdermal methods (e.g., via incorporation of theoligonucleotide reagent(s) of the invention into, e.g., emulsions, withsuch oligonucleotide reagents optionally packaged into liposomes). Suchtransdermal and emulsion/liposome-mediated methods of delivery aredescribed for delivery of antisense oligonucleotides in the art, e.g.,in U.S. Pat. No. 6,965,025, the contents of which are incorporated intheir entirety by reference herein.

The oligonucleotide reagents of the invention may also be delivered viaan implantable device (e.g., pacemaker or other such implantabledevice). Design of such a device is an art-recognized process, with,e.g., synthetic implant design described in, e.g., U.S. Pat. No.6,969,400, the contents of which are incorporated in their entirety byreference herein.

4. Pharmacogenomics

The therapeutic agents (e.g., an oligonucleotide reagent or vector ortransgene encoding same) of the invention can be administered toindividuals to treat (prophylactically or therapeutically) disordersassociated with aberrant or unwanted target gene activity. Inconjunction with such treatment, pharmacogenomics (i.e., the study ofthe relationship between an individual's genotype and that individual'sresponse to a foreign compound or drug) may be considered. Differencesin metabolism of therapeutics can lead to severe toxicity or therapeuticfailure by altering the relation between dose and blood concentration ofthe pharmacologically active drug. Thus, a physician or clinician mayconsider applying knowledge obtained in relevant pharmacogenomicsstudies in determining whether to administer a therapeutic agent as wellas tailoring the dosage and/or therapeutic regimen of treatment with atherapeutic agent.

5. Pharmaceutical Compositions

The invention pertains to uses of the above-described agents fortherapeutic treatments as described infra. Accordingly, the modulatorsof the present invention (e.g., oligonucleotides, small molecules andthe like) can be incorporated into pharmaceutical compositions suitablefor administration. Such compositions typically comprise the nucleicacid molecule, protein, antibody, or modulatory compound and apharmaceutically acceptable carrier. As used herein the language“pharmaceutically acceptable carrier” is intended to include any and allsolvents, dispersion media, coatings, antibacterial and antifungalagents, isotonic and absorption delaying agents, and the like,compatible with pharmaceutical administration. The use of such media andagents for pharmaceutically active substances is well known in the art.Except insofar as any conventional media or agent is incompatible withthe active compound, use thereof in the compositions is contemplated.Supplementary active compounds can also be incorporated into thecompositions.

A pharmaceutical composition of the invention is formulated to becompatible with its intended route of administration. Examples of routesof administration include parenteral, e.g., intravenous, intradermal,subcutaneous, intraperitoneal, intramuscular, oral (e.g., inhalation),transdermal (topical), and transmucosal administration. Solutions orsuspensions used for parenteral, intradermal, or subcutaneousapplication can include the following components: a sterile diluent suchas water for injection, saline solution, fixed oils, polyethyleneglycols, glycerine, propylene glycol or other synthetic solvents;antibacterial agents such as benzyl alcohol or methyl parabens;antioxidants such as ascorbic acid or sodium bisulfite; chelating agentssuch as ethylenediaminetetraacetic acid; buffers such as acetates,citrates or phosphates and agents for the adjustment of tonicity such assodium chloride or dextrose. pH can be adjusted with acids or bases,such as hydrochloric acid or sodium hydroxide. The parenteralpreparation can be enclosed in ampoules, disposable syringes or multipledose vials made of glass or plastic.

Pharmaceutical compositions suitable for injectable use include sterileaqueous solutions (where water soluble) or dispersions and sterilepowders for the extemporaneous preparation of sterile injectablesolutions or dispersion. For intravenous administration, suitablecarriers include physiological saline, bacteriostatic water, CremophorEL.™. (BASF, Parsippany, N.J.) or phosphate buffered saline (PBS). Inall cases, the composition must be sterile and should be fluid to theextent that easy syringability exists. It must be stable under theconditions of manufacture and storage and must be preserved against thecontaminating action of microorganisms such as bacteria and fungi. Thecarrier can be a solvent or dispersion medium containing, for example,water, ethanol, polyol (for example, glycerol, propylene glycol, andliquid polyetheylene glycol, and the like), and suitable mixturesthereof. The proper fluidity can be maintained, for example, by the useof a coating such as lecithin, by the maintenance of the requiredparticle size in the case of dispersion and by the use of surfactants.Prevention of the action of microorganisms can be achieved by variousantibacterial and antifungal agents, for example, parabens,chlorobutanol, phenol, ascorbic acid, thimerosal, and the like. In manycases, it will be preferable to include isotonic agents, for example,sugars, polyalcohols such as manitol, sorbitol, sodium chloride in thecomposition. Prolonged absorption of the injectable compositions can bebrought about by including in the composition an agent which delaysabsorption, for example, aluminum monostearate and gelatin.

Sterile injectable solutions can be prepared by incorporating the activecompound in the required amount in an appropriate solvent with one or acombination of ingredients enumerated above, as required, followed byfiltered sterilization. Generally, dispersions are prepared byincorporating the active compound into a sterile vehicle which containsa basic dispersion medium and the required other ingredients from thoseenumerated above. In the case of sterile powders for the preparation ofsterile injectable solutions, the preferred methods of preparation arevacuum drying and freeze-drying which yields a powder of the activeingredient plus any additional desired ingredient from a previouslysterile-filtered solution thereof.

Oral compositions generally include an inert diluent or an ediblecarrier. They can be enclosed in gelatin capsules or compressed intotablets. For the purpose of oral therapeutic administration, the activecompound can be incorporated with excipients and used in the form oftablets, troches, or capsules. Oral compositions can also be preparedusing a fluid carrier for use as a mouthwash, wherein the compound inthe fluid carrier is applied orally and swished and expectorated orswallowed. Pharmaceutically compatible binding agents, and/or adjuvantmaterials can be included as part of the composition. The tablets,pills, capsules, troches and the like can contain any of the followingingredients, or compounds of a similar nature: a binder such asmicrocrystalline cellulose, gum tragacanth or gelatin; an excipient suchas starch or lactose, a disintegrating agent such as alginic acid,Primogel, or corn starch; a lubricant such as magnesium stearate orSterotes; a glidant such as colloidal silicon dioxide; a sweeteningagent such as sucrose or saccharin; or a flavoring agent such aspeppermint, methyl salicylate, or orange flavoring.

For administration by inhalation, the compounds are delivered in theform of an aerosol spray from pressured container or dispenser whichcontains a suitable propellant, e.g., a gas such as carbon dioxide, or anebulizer.

Systemic administration can also be by transmucosal or transdermalmeans. For transmucosal or transdermal administration, penetrantsappropriate to the barrier to be permeated are used in the formulation.Such penetrants are generally known in the art, and include, forexample, for transmucosal administration, detergents, bile salts, andfusidic acid derivatives. Transmucosal administration can beaccomplished through the use of nasal sprays or suppositories. Fortransdermal administration, the active compounds are formulated intoointments, salves, gels, or creams as generally known in the art.

The compounds can also be prepared in the form of suppositories (e.g.,with conventional suppository bases such as cocoa butter and otherglycerides) or retention enemas for rectal delivery.

In one embodiment, the active compounds are prepared with carriers thatwill protect the compound against rapid elimination from the body, suchas a controlled release formulation, including implants andmicroencapsulated delivery systems. Biodegradable, biocompatiblepolymers can be used, such as ethylene vinyl acetate, polyanhydrides,polyglycolic acid, collagen, polyorthoesters, and polylactic acid.Methods for preparation of such formulations will be apparent to thoseskilled in the art. The materials can also be obtained commercially fromAlza Corporation and Nova Pharmaceuticals, Inc. Liposomal suspensions(including liposomes targeted to infected cells with monoclonalantibodies to viral antigens) can also be used as pharmaceuticallyacceptable carriers. These can be prepared according to methods known tothose skilled in the art, for example, as described in U.S. Pat. No.4,522,811.

It is especially advantageous to formulate oral or parenteralcompositions in dosage unit form for ease of administration anduniformity of dosage. Dosage unit form as used herein refers tophysically discrete units suited as unitary dosages for the subject tobe treated; each unit containing a predetermined quantity of activecompound calculated to produce the desired therapeutic effect inassociation with the required pharmaceutical carrier. The specificationfor the dosage unit forms of the invention are dictated by and directlydependent on the unique characteristics of the active compound and theparticular therapeutic effect to be achieved, and the limitationsinherent in the art of compounding such an active compound for thetreatment of individuals. Toxicity and therapeutic efficacy of suchcompounds can be determined by standard pharmaceutical procedures incell cultures or experimental animals, e.g., for determining the LD50(the dose lethal to 50% of the population) and the ED50 (the dosetherapeutically effective in 50% of the population). The dose ratiobetween toxic and therapeutic effects is the therapeutic index and itcan be expressed as the ratio LD50/ED50. Compounds that exhibit largetherapeutic indices are preferred. Although compounds that exhibit toxicside effects may be used, care should be taken to design a deliverysystem that targets such compounds to the site of affected tissue inorder to minimize potential damage to uninfected cells and, thereby,reduce side effects. The data obtained from the cell culture assays andanimal studies can be used in formulating a range of dosage for use inhumans. The dosage of such compounds lies preferably within a range ofcirculating concentrations that include the ED50 with little or notoxicity. The dosage may vary within this range depending upon thedosage form employed and the route of administration utilized. For anycompound used in the method of the invention, the therapeuticallyeffective dose can be estimated initially from cell culture assays. Adose may be formulated in animal models to achieve a circulating plasmaconcentration range that includes the EC50 (i.e., the concentration ofthe test compound which achieves a half-maximal response) as determinedin cell culture. Such information can be used to more accuratelydetermine useful doses in humans. Levels in plasma may be measured, forexample, by high performance liquid chromatography.

The pharmaceutical compositions can be included in a container, pack, ordispenser together with instructions for administration.

This invention is further illustrated by the following examples whichshould not be construed as limiting. The contents of all references,patents and published patent applications cited throughout thisapplication are incorporated herein by reference.

EXAMPLES Example 1

Modulation of aberrant splicing using antisense oliogonucleotides (ASOs)is an emerging technology with tremendous therapeutic potential. AnASO-based approach could be also employed to determine uniqueinteractions that are difficult to uncover using traditional means ofdeletion and substitution mutations. Here we report a novel finding ofan antisense microwalk in which we examined the position-specific roleof intronic residues downstream of the 5′ splice site (5′ ss) of SMN2exon 7, skipping of which is associated with Spinal Muscular Atrophy(SMA), a leading genetic cause of infant mortality. Our results revealedthe inhibitory role of a cytosine residue at the 10^(th) intronicposition (¹⁰C), which is neither conserved nor associated with any knownsplicing motif Significance of ¹⁰C emerged from the splicing pattern ofSMN2 exon 7 in presence of a 14-mer ASO (L14) that sequestered twoadjacent hnRNP A1 motifs downstream of ¹⁰C and yet promoted SMN2 exon 7skipping. Another 14-mer ASO (F14) that sequestered both, ¹⁰C andadjacent hnRNP A1 motifs, led to a strong stimulation of SMN2 exon 7inclusion. The inhibitory role of ¹⁰C was found to be tightly linked toits unpaired status and specific positioning immediately upstream of aRNA:RNA helix formed between the targeting ASO and its intronic target.Employing a heterologous context as well as changed contexts of SMN2intron 7, we show that the inhibitory effect of unpaired ¹⁰C isdependent upon a long-distance interaction involving downstream intronicsequences. Our report furnishes one of the rare examples in which anASO-based approach could be applied to unravel the critical role of anintronic position that may not belong to a linear motif and yet playsignificant role through long-distance interactions.

Alternative splicing is an essential process in the generation ofprotein diversity and has been a major contributory force to genomeevolution (Xing and Lee 2007). Current estimates suggest that 95-100% ofhuman genes with two or more exons are alternatively spliced affectingall major aspects of cellular metabolism (Nilsen and Graveley 2010).Splicing is catalyzed by a spliceosome that represents one of the mostcomplex macromolecular machines known (Nilsen 2003; Matlin and Moore2007). Control of alternative splicing rests on non-spliceosomal factorsthat bind to pre-mRNA sequences called exonic or intronic splicingenhancers (ESEs or ISEs) and silencers (ESSs or ISSs) (Lin and Fu 2007;Martinez-Contreras et al. 2007; David and Manley 2008). Enhancer andsilencer motifs promote or suppress splice-site (ss) selection,respectively. Methods to identify splicing motifs are continuing toevolve (Chasin 2007; Singh 2007a; Hertel 2008; Wang and Burge 2008; Yuet al. 2008). An additional regulatory role is provided by RNAstructures that enforce accessibility to splicing elements, as well asbring two distantly located cis-elements in close proximity (Graveley2005; Buratti et al. 2007; Singh et al. 2007, Shepard and Hertel 2008;Warf et al. 2009). Unraveling the mechanism by which splicing factors,RNA regulatory sequences and structural motifs coordinate to regulatealternative splicing is an area of growing interest for evolvingstrategies to cure many human diseases associated with defectivesplicing (Garcia-Blanco 2006; Tazi et al. 2009; Cooper et al. 2009; Wardand Cooper 2010).

Despite a tremendous progress in our understanding of pre-mRNA splicing,validation of splicing motifs in the context of an endogenous gene hasremained a daunting task. Antisense oligonucleotide (ASO)-basedapproaches offer an extraordinary potential to address this issue withadditional implication to therapy of human diseases (Hua et al. 2008;Bauman et al. 2009). Refinements of ASO-based strategies have capabilityto provide information regarding the accessibility and the role ofcertain regions within RNA sequence. For example, ASO scanning arrayshave been employed to probe alternative folding of RNA sequences (Oomset al. 2004). The most exciting future application of an ASO-basedapproach includes identification of the critical role of an individualresidue in pre-mRNA splicing using endogenous context. Such studieswould address the role of the nonlinear motifs with implications tohigh-order interactions and structural rearrangements.

Humans have two nearly identical copies of the Survival Motor Neuron(SMN) gene: SMN1 and SMN2 (Lefebvre et al. 1995). The two SMN genes codefor identical proteins; however, SMN2 predominantly generates a shorttranscript due to skipping of exon 7, producing a truncated SMN that ishighly unstable (Vine et al. 2007). The inability, of SMN2 to compensatefor the loss of SMN1 results in spinal muscular atrophy (SMA), adebilitating disease of children and infants (Wirth et al. 2006). SinceSMN2 is almost universally present in SMA patients, correction of SMN2exon 7 splicing holds the promise for cure. Due to anticipated targetspecificity, a large number of studies have focused on ASO-basedapproaches to restore SMN2 exon 7 inclusion (Bauman et al. 2009). Amongthese studies, our earlier reported intronic splicing silencer N1(ISS-N1) has emerged as a leading target in a systematic antisensemicrowalk (Singh et al. 2006; Hua et al. 2008). Consistently, a recentreport has independently confirmed the high therapeutic potential ofISS-N1 by demonstrating that blocking ISS-N1 with an ASO substantiallyelevated the SMN levels in brain of SMA mice (Williams et al. 2009).

ISS-N1 is a mixed compOsition sequence spanning from the 10^(th) to24^(th) position of intron 7 (Singh et al. 2006; FIG. 1A). Due to itsstrategic location and strong negative impact, ISS-N1 has been termed asthe master checkpoint (Buratti et al. 2006). The 15-nucleotide-longISS-N1 harbors two putative hnRNP Al motifs that have been proposed tobe responsible for its inhibitory impact (Hua et al. 2008; FIG. 1A).Using an ultra-refined antisense micro-walk, we have recently shown thatISS-N1 overlaps with an 8-nucleotide-long GC-rich sequence spanning fromthe 7^(th) to 14^(th) position of intron 7 (Singh et al. 2009; FIG. 1A).We have also shown that sequestering of this GC-rich sequence with an8-mer ASO fully restores SMN2 exon 7 inclusion in SMA patient cells(Singh et al. 2009). Interestingly, the stimulatory effect of the 8-merASO comes without full sequestration of any of the validated hnRNP A1binding sites. Thus, our results open a possibility of the role of anadditional negative element and/or structural motif associated with theGC-rich sequence in the vicinity of the 5′ splice site (5′ ss). We haveearlier reported the inhibitory role of a RNA structure (terminalstem-loop 2 or TSL2) sequestering the 5′ ss of SMN2 exon 7 (Singh et al.2007). It remains to be seen if a factor interacting with TSL2 makes asecondary contact with the downstream GC-rich sequence or vice-versa.

Given the large number of ASOs tested (against ISS-N1), ISS-N1 standsout among other splicing-correcting antisense targets reported thus far.Nevertheless, not all size combinations of ASOs targeting ISS-N1 and itsneighboring sequences have been examined. Consequently, the publishedresults do not address the role of specific residues that fall beyondthe traditional definition of motifs associated with the known splicingfactors. Here we take advantage of an additional antisense microwalk toreveal the critical role of a cytosine residue at the 10^(th) positionof human SMN2 intron 7 in conferring the nature of the antisenseresponse. We refer this residue as ¹⁰C here after. ¹⁰C represents thefirst residue of ISS-N1 but does not belong to any of the known motifs,including hnRNP A1. Our study revealed a rare finding in which twoidentical size ASOs whose target differed by a single nucleotide (oneASO sequestered ¹⁰C, whereas other did not) produced an opposite effecton SMN2 exon 7 splicing. We confirmed that unsequestered ¹⁰C plays astrong negative role when combined with an ASO targeting a 14-nucleotidesequence immediately downstream of ¹⁰C. We also show that the inhibitoryeffect of unsequestered ¹⁰C is dependent upon a long-distanceinteraction involving downstream intronic sequences. Our findingsunderscore the potential of an ASO-based approach in unraveling theparamount significance of a single intronic nucleotide due to itslocation relative to other splicing cis-elements within an entireintron.

Identification of a Master Position within the Core of the AntisenseTarget

Substantial evidence and independent validations confirm that ISS-N1 isan ideal target for an ASO-mediated correction of aberrant splicingassociated with a major genetic disease (Singh et al. 2006, 2009; Hua etal. 2008; Williams et al. 2009). Based on a stimulatory effect of ASOstargeting ISS-N1 and the GC-rich sequence, we have established that thefirst five residues of ISS-N1 constitute the core of antisense target(Singh et al. 2009). ¹⁰C occupies the first position of this core and isstrategically located in the middle of the GC-rich sequence (FIG. 1).The significance of ¹⁰C emerges from the fact that it may participate inhigh-order interaction because it does not fall within the confines ofthe recently described hnRNP A1 motifs proposed to be a cause for thenegative effect associated with ISS-N1 (Hua et al. 2008; Singh et al.2009).

To further examine the role of ¹⁰C as an integral part of the antisensetarget we performed an additional ultra-refined antisense micro-walk. Weused ASOs of varying sizes that blocked different portions of ISS-N1with or without sequestering ¹⁰C. Of note, since ISS-N1 is a15-nucleotide-long element, we confined our comparison of antisenseeffect to 15-mer or shorter ASOs (Anti-N1 being the only exception).Annealing positions of ASOs are diagrammatically shown in FIG. 1B.Sequences of all ASOs used in this study are given in Table 1. For thesake of simplicity, we used an antisense nomenclature comprised of aletter(s) followed by a number that represents the size of an ASO. Fseries ASOs possess the identical 3′ ends with the first position ofISS-N1 being complementary to the 3′-terminal nucleotides of ASOs. Lseries ASOs possess the identical 5′ ends with the last position ofISS-N1 being complementary to the 5′-terminal nucleotides of ASOs. Mseries ASOs block sequences in the middle of ISS-N1. Other ASOscontaining UP and DN letters sequester residues upstream and downstreamof ISS-N1, respectively. Here, we performed antisense screening at arelatively low ASO concentration of 20 nM. Our earlier reported ASOsthat sequestered ¹⁰C served as positive controls (FIG. 1B, green bars).SEQ ID NO: 4-25 respectively.

TABLE 1 Anti-N1:  5′AUUCACUUUCAUAAUGCUGG3′ F15:      5′CUUUCAUAAUGCUGG3′1UP15:       5′UUUCAUAAUGCUGGC3′ 2UP15:        5′UUCAUAAUGCUGGCA3′3UP15:         5′UCAUAAUGCUGGCAG3′ 1DN15:     5′ACUUUCAUAAUGCUG3′ 2DN15:   5′CACUUUCAUAAUGCG3′ 3DN15:   5′UCACUUUCAUAAUGC3′ F14:      5′UUUCAUAAUGCUGG3′ L14:      5′CUUUCAUAAUGCUG3′ F13:       5′UUCAUAAUGCUGG3′ L13:      5′CUUUCAUAAUGCU3′ M13:      5′UUUCAUAAUGCUG3′ F12:         5′UCAUAAUGCUGG3′ M12F:       5′UUCAUAAUGCUG3′ M12L:       5′UUUCAUAAUGCU3′ F11:         5′CAUAAUGCUGG3′ F10:           5′AUAAUGCUGG3′ F9:           5′UAAUGCUGG3′ F14comp:       5′UUUCAUACUUCUGG3′ L14comp:     5′CUUUCAUACUUCUG3′ F14LNA:       5′TTTCAUAATGCTGG3′ FL14LNA:     5′CTTTCATAATGCTG3′

As shown in FIG. 1C, ASOs that did not sequester ¹⁰C failed to produceany stimulatory response on SMN2 exon 7 inclusion and in some instanceseven caused an increase in SMN2 exon 7 skipping. The most strikingexample was L14, particularly when the effect of this ASO was comparedto the effect of F14. Note that both ASOs are 14-nucleotide-long, the GCcontent of their targets is the same, and their annealing positionsdiffer by only one nucleotide, ¹⁰C. Yet F14 and L14 produce oppositeeffects on exon 7 splicing: F14 that sequestered ¹⁰C. efficientlyrestored SMN2 exon 7 inclusion, while L14 that did not block ¹⁰Cincreased exon 7 skipping (FIG. 1C). Antagonistic effects of F14 and L14were verified by three different batches of ASOs synthesized atdifferent times. Also, we performed experiments at variousconcentrations ranging from 1 nM to 1 μM. Stimulatory effect of F14increased with the increasing concentrations of F14, whereas theinhibitory effect of L14 increased with the increasing concentrations ofL14 (not shown). Of note, L14 sequestered both hnRNP A1 motifs withinISS-N1 and yet promoted SMN2 exon 7 skipping. Other short ASOs that didnot sequester ¹⁰C had less pronounced negative effects. For example, L13and M13 that are only one-nucleotide shorter than L14, showedsubstantially reduced if any negative effects on SMN2 exon 7 splicing.Similar results were observed with M12F and M12L that annealed to thetwelve-nucleotide-long sequences in the middle of ISS-N1. We also tested15-mer ASOs that did not sequester ¹⁰C but targeted sequencesimmediately downstream of ¹⁰C. These 15-mer ASOs produced inhibitoryresponse albeit at higher concentrations (not shown).

Next, we wished to verify that the antagonistic effects of F14 and L14on splicing of SMN2 exon 7 were not specific to the chemistry of ASOs.Note that in our ultra-refined microwalk described above, the ASOs haduniform phosphorothioate backbone and 2′-O-methyl modifications (FIG.1D). For comparison, we chose F14 and L14 with locked nucleic acid (LNA)chemistry in which an extra-bridge that connects 2′-oxygen and 4′-carbonof ribose sugar is added (FIG. 1D). LNAs display unprecedentedhybridization affinity toward complementary single-stranded RNA and havebeen widely used in a variety of applications (Veedu and Wengel 2009).In LNAs used in our experiments, we also replaced uracyl residues withthymidine residues. Such replacement has a potential to improve basepairing with adenosine residues. To increase the intracellular stabilityof LNAs, we incorporated uniform phosphorothioate backbone. LNAscorresponding to F14 and L14 were named as F14LNA and L14LNA,respectively. As shown in FIG. 1D, F14LNA and L14LNA retained theircharacteristic antagonistic effects. These results validated the factthat sequestering of ¹⁰C is essential for producing the stimulatoryresponse irrespective of the chemistry of ASO. In addition, our resultsshowed that inhibitory effect of unsequestered ¹⁰C does not depend onthe chemistry of the duplex formed between an ASO and its ISS-N1 target.

Antisense Effect is Specific to Base Paring with Target

Having discovered that two antisense targets differing by a singlenucleotide could produce antagonistic effect upon annealing to theircognate ASOs, we next examined the efficacy and specificity of theseASOs using SMN2 minigene system. For this, HeLa cells wereco-transfected with the minigene (0.1 μg) and an ASO of interest (50 nM)and the effect on splicing was accessed by RT-PCR. To avoid theoff-target effect, we deliberately chose a lower range of minigene andASO concentrations that we have determined to be optimum for modulationof SMN2 exon 7 splicing (Singh et al. 2009). As shown in FIG. 2A, theantisense effect on splicing of SMN2 minigene was consistent with theresults for the endogenous SMN2 in SMA patient fibroblasts: F14increased exon 7 inclusion, while L14 increased exon 7 skipping. Theseresults validate the necessity of sequestration of ¹⁰C for thestimulatory response of ASOs targeting ISS-N1. Our results also suggestthat sequences upstream of exon 6 do not modulate the response of ASOstargeting ISS-N1. When F14 and L14 were mutated giving rise to ASOs wecalled F14comp and L14comp, their effect on SMN2 exon 7 splicing wasobviated (FIG. 2A). These results suggest that the positive effect ofF14 and negative effect L14 on splicing of exon 7 are dependent on ASObase pairing with their respective target sites.

To further validate that the opposite effects of F14 and L14 are not dueto interactions with non-specific targets, we performed a key experimentin which ASOs were co-transfected with our earlier described mutantminigene, SMN2/I7-08. This minigene has C-to-A and U-to-G substitutionsat the 5^(th) and the 7^(th) positions of ISS-N1, respectively. We haveshown that these substitutions have capability to weaken the RNA:RNAduplex formed between Anti-N1 and ISS-N1 (Singh et al. 2006).Consistently, both F14 and L14 lost their respective antisense effectswhen co-transfected with SMN2/17-08 (FIG. 2B), confirming their targetspecificity. At the same time, F14comp and L14comp, which showed perfectcomplementarity with the mutated ISS-N1 within SMN2/17-08, produced therespective antisense effect similar to the outcome of F14 and L14sequestration of the wild type ISS-N1 (FIG. 2B). These results alsounderscore that the inhibitory effect of untargeted ¹⁰C is not linked tothe sequence of duplex formed between an ASO and its target withinISS-N1 region.

Site-Specific Mutations Confirm the Negative Impact of Unpaired ¹⁰C

We next wished to investigate a possible mechanism behind the negativeeffect of L14 on SMN2 exon 7 splicing. We began addressing this issue byemploying a SMN2 mutant minigene (SMN2Δ64) in which ¹⁰C was deletedbringing the target of L14 one nucleotide closer to the 5′ ss. As shownin FIG. 3A, the deletion of ¹⁰C somewhat increased exon 7 skipping ascompared to the wild type SMN2, indicating that the negative effect ofISS-N1 could be retained without ¹⁰C. Interestingly, when co-transfectedwith SMN2Δ64, L14 showed a strong stimulatory response on exon 7inclusion (FIG. 3A). This result validated the inhibitory nature ofunsequestered ¹⁰C in the context of the L14:target duplex (L14-duplex)and underscored a rare finding that deletion of a single intronicposition upstream of a target sequence could reverse the impact ofantisense response. Interestingly, F14 maintained its stimulatory effectin SMN2Δ64 despite a one-nucleotide overhang at the 3′ end due to thedeletion of ¹⁰C. However, improvement of exon 7 inclusion in thepresence of F14 was milder than the one produced by L14, probably due tothe fact that the RNA:RNA duplex formed by L14 and its target was longerby one nucleotide.

To further confirm that the inhibitory effect of L14 is due tountargeted ¹⁰C in the context of L14-duplex, we used 5′1U-F15. This ASOis identical to L14 except it has an additional uracyl residue added atits 3′-end. Note that this residue does not base pair with ¹⁰C but iscapable of sterically preventing the accessibility of ¹⁰C (FIG. 3B). Asshown in FIG. 3B, 5′1U-F15 completely overcame the inhibitory responseof L14. However, it was unable to produce a stimulatory response sinceit did not effectively sequester ¹⁰C.

To test whether the inhibitory effect of L14-duplex is specificallylinked to the type of residue at the 10^(th) intronic position, we usedSMN2/64A minigene in which ¹⁰C residue was replaced with an adenosineresidue (¹⁰A). This mutation did not change the splicing pattern of SMN2(FIG. 3B) allowing more accurate comparison of the antisense responsewith and without the sequestration of the 10^(th) intronic nucleotide.Surprisingly, L14 produced a strong stimulatory effect in the context of¹⁰A confirming that the inhibitory effect of L14-duplex in the wild typecontext is solely linked to an untargeted cytosine residue at the10^(th) intronic position. Consistent with the neutral role of theunpaired ¹⁰A, ASOs such as F15, F14 and 1DN15 also produced stimulatoryeffect on exon 7 inclusion in SMN2/64A minigene. The effects of theseASOs were similar to 5′1U-F15 that sequestered the ¹⁰A (FIG. 3B).

Effect of the Immediate Context on the Antisense Response

In order to examine the role of the immediate context of target sequenceon the antisense response, we used our previously described SMN2minigene mutants (Singh et al. 2006). In SMN2/5A and SMN2/5G fiveadenosine and guanosine residues were inserted before ISS-N1,respectively. Such arrangement will place ¹⁰C. away from the 5′ ss andalter the nature of a presumptive long-distance and/or short-distanceinteractions that are specific to a nucleotide located at a particularposition. When transfected in HeLa cells, SMN2/5A and SMN2/5G showedsomewhat less skipping of exon 7 as compared to the wild type SMN2minigene (FIG. 4B). Upon treatment with F14, both SMN2/5A and SMN2/5Gshowed increased exon 7 inclusion, suggesting that the effect of F14 isexclusively based on the blocking of a linear cis-element comprised oftwo putative hnRNP A1 binding sites. Our results also confirmed that theeffect of F14 is not sensitive to the precise location of target sitewith respect to the 5′ ss. On the other hand, L14 produced a decreasednegative effect, suggesting that a combination of unsequestered ¹⁵C andL14-duplex is less inhibitory than a combination of unsequestered ¹⁰Cand L14-duplex. Overall our results support that relative positioning ofan antisense target with respect to the 5′ ss may be important fordetermining the impact of an unsequestered residue preceding an RNA:RNAduplex formed between the target and an ASO.

To further understand the impact of the local context on the antisenseresponse, we used N1Δ30-34 and N1Δ25-34 minigenes in which five and tenresidues were deleted immediately downstream of ISS-N1, respectively(FIG. 4A). These deletions are likely to break any secondary structureoverlapping ISS-N1. When transfected in HeLa cells, transcripts derivedfrom both of the above mutants displayed increased exon 7 skipping (FIG.4B). In both of these mutants, F14 and L14 produced strong stimulatoryand inhibitory effect, respectively. Since these mutants retain therelative positioning of ISS-N1 with respect to the 5′ ss, the antisenseresponse was very similar to the one in the wild type context. Theseresults also suggest that the inhibitory effect of the combination of anuntargeted ¹⁰C and the downstream L14-duplex might not be affected bythe sequences immediately downstream of ISS-N1. However, our results donot rule out the role of further downstream intronic sequences that mayinteract with the untargeted ¹⁰C during the catalytic core formation.

Effect of the Heterologous Context on the Antisense Response

Studies in a heterologous system provide valuable information regardingportability of a cis-element in question. Linear cis-elements are easilyportable in a heterologous context, whereas complex cis-elementsinvolving long-distance interactions are generally not portable. We havepreviously shown that ISS-N1 is a portable cis-element because itsinsertion at the identical location within intron 6 of Caspase 3 (Casp3)minigene promotes skipping of Casp3 exon 6 (Singh et al. 2006). Indeed,when transfected in Hela cells, Casp3ISS-N1 minigene showed 43% of Casp3exon 6 skipping as compared to 19% observed in Casp3Avr minigene thatlacks ISS-N1 (FIGS. 5A and B). 3′-Cluster is another negative elementlocated upstream of the 5′ ss of SMN2 exon 7 (Singh et al. 2004a).Interestingly, insertion of this element at the similar locationrelative to the 5′ ss (3 nucleotide upstream of the exon/intronjunction, FIG. 5A) in Casp3 exon 6 (Casp3-3′C1 minigene) caused moderateincrease in skipping of this exon (FIG. 5B). When both 3′-Cluster andISS-N1 were inserted in Casp3 minigene (Casp3N1C1 mutant, FIG. 5A),skipping of Casp3 exon 6 increased to 90% (FIG. 5B). Note that inCasp3N1C1 mutant we tried to recreate “SMN2” arrangement of ISS-N1 and3′-Cluster relative to each other and the 5′ ss. For this purpose ISS-N1and 3′-Cluster were inserted 9 and 3 nucleotides down- and up-stream ofthe 5′ ss of Casp3 exon 6, respectively (FIG. 5A). Since Casp3N1C1showed the highest amount of exon skipping (FIG. 5B), we decided to usethis minigene to test the effect of ISS-N1 targeting by F14 and L14 onsplicing of the “heterologous” exon. As shown in FIG. 5C, when Casp3N1C1was co-transfected with F14, inclusion of Casp3 exon 6 increasedsignificantly. Surprisingly, L14 also produced a moderate stimulatoryresponse despite the unsequestered ¹⁰C (FIG. 5C). We observed similarresults using Casp3-SMN5′-1 minigene in which twelve residues between3′-Cluster and ISS-N1 (last three exonic and first nine intronicresidues) were replaced with SAM sequence (FIG. 5A). The replacedresidues combined with the 3′-Cluster and ISS-N1 introduced the 5′ ss“environment” of SMN2 exon 7 in Casp3 minigene. Yet, in Casp3 contextthe combination of the unsequestered ¹⁰C and L14-duplex was unable toproduce an inhibitory effect observed in SMN2. These results suggested apossible role of additional sequences in conferring the negative effectassociated with unsequestered ¹⁰C.

Absence of negative effect of L14 in heterologous context could be dueto the lack of cooperative interactions among cis-elements that defineboth, the 3′ and 5′ ss of SMN2 exon 7. To address this issue, we createda hybrid minigene (Casp3SMN2) in which we replaced the entire middleexon and flanking intronic sequences of Casp3 splicing cassette with 269nucleotides of SMN2 containing entire exon 7, 116 nucleotides ofupstream intron 6 and 99 nucleotides of downstream intron 7 (FIG. 5D).Thus, Casp3SMN2 provided an opportunity to evaluate the effect of F14and L14 in a “semi-heterologous” system in which large portions of wildtype context defining the 3′ and 5′ ss of SMN2 exon 7 were present. Atthe same time, Casp3SMN2 minigene retained the Casp3 context thatdefines the 5′ ss of upstream and 3′ ss of downstream exons. As shown inFIG. 5D, when Casp3SMN2 was co-transfected with either F14 or L14, bothASOs promoted exon 7 inclusion. These results indicated that theinhibitory effect of unsequestered ¹⁰C is linked to a long-distanceinteraction that could not be formed in the context of Casp3SMN2. Ourresults also suggested that the splicing factors directly interactingwith exon 7 and the flanking intronic sequences are not involved inproducing inhibitory effect associated with unsequestered ¹⁰C upstreamof L14-duplex.

Inhibitory Effect of ¹⁰C is Linked to an Intra-Intronic Long-DistanceInteraction

Based on the corroborative evidence of experiments described in FIGS.3-5, the most plausible mechanism of inhibitory effect of unsequestered¹⁰C would be involvement of a long-distance interaction(s). To exploresuch possibility, we generated SMN2 minigene mutants with largedeletions within intron 6 and intron 7 farther away from the 3′ and 5′ss of exon 7. These mutants were then used to test the effect of F14 andL14 on exon 7 splicing. As shown in FIG. 6, when the 3′ portion ofintron 7 was deleted (I7Δ190-406) the negative effect of L14 on exon 7splicing was abrogated and it became almost as effective in restoringthe inclusion of exon 7 as F14. However, in SMN2 mutant with a deletionin intron 6 (I16Δ-80-199D) L14 still retained its inhibitory effect onexon 7 splicing (FIG. 6). Interestingly, when I6Δ-80-199D deletion wascombined with I7×190-406 deletion (mutant I6Δ/I7Δ), L14 again lost itsinhibitory effect despite the unsequestered ¹⁰C (FIG. 6B). These resultsare in line with the effect of F14 and L14 on exon 7 splicing in thehybrid Casp3SMN2 minigene that lacks similar regions of intron 6 andintron 7 (FIG. 5D). The observation that L14 lost its ability toincrease exon 7 skipping when the region between positions 188 and 407of intron 7 was missing provided the first indication of a potentiallong-distance interaction between untargeted ¹⁰C and a sequence upstreamof the 3′ ss of exon 8. In other words, our results suggest that theinhibitory effect of untargeted ¹⁰C upstream of L14-duplex is intimatelylinked to sequences upstream of the 3′ ss of exon 8.

Next we wanted to determine if a specific sequence upstream of the 3′ ssof exon 8 was involved in long-distance interactions with untargeted¹⁰C. Since the deletion in the 3′ portion of intron 7 that abolished thenegative impact of untargeted ¹⁰C in the context of L14-duplex wasrather large (from 190^(th) and 406^(th) positions), we generatedseveral SMN2 mutants with smaller overlapping deletions in this area andco-transfected them with F14 and L14. Based on the results shown in FIG.7, F14 treatment effectively restored inclusion of SMN2 exon 7 in allmutants, while the response to L14 appeared to depend upon size andlocation of deletion within intron 7. For example, several sets ofoverlapping deletions in the 3′ region of intron 7 resulted into theloss of inhibitory effect and/or gain of stimulatory effect on exon 7inclusion when the deletion size was 72 nucleotides or more (FIG. 7). Inparticular, when mutants SMN2-I7Δ195-306 and SMN2-I7Δ287-393 withdeletions of 112 and 107 nucleotides, respectively, were co-transfectedwith L14, exon 7 inclusion increased ˜2.5 times as compared to “mock”co-transfection (FIG. 7B). At the same time, L14 produced no stimulatoryeffect on mutant with equally large (115-nucleotide long) deletion inthe 5′ portion of intron 7 (SMN2-I7Δ30-144) (FIG. 7B). Since ISS-N1harbors the only target site for L14 within entire SMN2, the loss ofinhibitory effect of L14 in deletion mutants could be directly linked tothe loss of a long-distance interaction associated with the deletedsequences. Based on our results we conclude that long-distanceinteraction are area specific and not sequence specific. Our results ofSMN2 intron 7 deletions do not support a straightforward mechanism ofloss of L14 inhibitory effect as a consequence of the reduced size ofintron 7. Further supporting this argument, a much larger downstreamintron (˜1.6 kb) in the heterologous context of Casp3SMN2 fusionminigene did not recapitulate the inhibitory effect of an untargeted ¹⁰Cupstream of L14-duplex (FIG. 5D).

Antagonistic Effect of ASOs is not Linked to the DifferentialDisplacement of hnRNP A1

hnRNP A1 motifs located within ISS-N1 have been linked to skipping ofSMN2 exon 7 (Hua et al. 2008). Since F14 and L14 produce an oppositeeffect on exon 7 splicing, we wished to test whether these ASOs displayany disparity in their ability to prevent binding of hnRNP A1 to ISS-N1.For this purpose we performed in vitro experiments using a purifiedrecombinant hnRNP A1 protein. The purification of hnRNP A1 was doneusing an IMPACT (Intein Mediated Purification with an AffinityChitin-binding Tag) system that allows a single-column purification ofan Escherichia coli expressed protein without vector-derived amino acidsor affinity tags. As shown in the FIG. 8A, we were able to obtain anearly homogenous (more than 90% pure) hnRNP A1 preparation.

We then used site-specific UV-crosslinking to probe the interaction ofthe purified hnRNP A1 with ISS-N1. The 50-nucleotide long RNA probe usedfor UV-crosslinking contained the last 18 residues of exon 7 and thefirst 32 residues of intron 7 of SMN2, including the ISS-N1 region (FIG.8B). To capture a direct interaction of hnRNP A1 with ISS-N1, a singleradioactive ³²P-moeity was introduced between the 5^(th) and the 6^(th)residue of ISS-N1. These residues fall within the first hnRNP A1 motifof ISS-N1 (FIG. 1A). The conditions of UV-crosslinking experiments wereoptimized to obtain the sufficient amount of hnRNP A1-crosslinkedproduct following RNase digestion. The results of site-specificUV-crosslinking confirmed that purified hnRNPA1 binds at the sitecontaining radioactive moiety (FIG. 8C). Having established that hnRNPA1 can be site-specifically crosslinked to ISS-N1, we sought toinvestigate whether a sequestration of ISS-N1 with F14 or L14 is able toprevent hnRNP A1 binding. For this purpose the site-specifically labeledRNA probe was denatured and refolded in the presence of either F14 orL14 prior to addition of hnRNP A1 and UV-crosslinking. As controls weused the mutant ASOs, F14comp and L14comp. As described earlier, theseASOs produce no antisense effect due to the mismatch mutations (FIG. 2).As shown in FIG. 8D, F14 and L14 were equally efficient in preventingthe binding of hnRNP A1 to ISS-N1 as indicated by the substantialdecrease in the amount of hnRNP A1-crosslinked product as compared to“No ASO” and F14comp/L14comp controls.

In the next experiment the site-specifically labeled RNA probe wasrefolded prior to addition of the ASOs and hnRNP A1. Since the ASOs wereadded to the reaction mixture after the RNA probe was refolded, thisexperiment validated the accessibility of the target under the nativeconditions. Also it tested the affinity of hnRNP A1 for its “native”target in the presence of ASOs. Here again we used F14comp and L14compas control ASOs. As shown in FIG. 8E, again F14 and L14 were equallyefficient in preventing hnRNP A1 binding, whereas control ASOs had noeffect. Our results also confirmed that sequestration of ¹⁰C was notrequired for the displacement of hnRNP A1.

An Untargeted Cytosine Decides the Outcome of the Target-SpecificAntisense Response

ISS-N1 has emerged as one of the best-studied intronic antisense targetsfor splicing correction in a major human disease. The 15-nucleotide longISS-N1 has the distinction of harboring two putative hnRNP A1 motifscovering its last 14 residues (Hua et al. 2008). The first five residuesof ISS-N1 together with the three upstream residues constitute an8-nucleotide-long GC-rich motif (FIG. 1A). Sequestration of eitherGC-rich motif or first fourteen nucleotides of ISS-N1 has the capabilityto fully restore SMN2 exon 7 inclusion in SMA patient cells at lownanomolar concentrations (Singh et al. 2006, 2009). Based on thesefindings, the first five residues of ISS-N1 constitute the core of theabove two antisense targets (Singh et al. 2009). Although, the GC-richsequence is the shortest known target for effective splicing correctionin a patient cell line, the mechanism by which sequestration of thissequence restores SMN2 exon 7 inclusion is not known. Upon annealing toits target, an ASO has a capability to break the local context byintroducing a double helical structure that affects the orientation ofresidues upstream and downstream of the helix. Hence, an ASO-basedapproach provides a unique opportunity to test the significance ofcertain residues at specific positions even though these positions arenot directly targeted by an ASO. Here we report a rare finding in whichan untargeted cytosine residue at the 10^(th) intronic position (¹⁰C)decides the outcome of the antisense response of ASOs that targetsequences immediately downstream of ¹⁰C. A critical role of ¹⁰C wasfound to stem from its unique location within the GC-rich motif at aprecise distance from the 5′ ss of exon 7.

The significance of unsequestered ¹⁰C in conferring the outcome ofISS-N1-targeting by ASOs was best captured by F14 and L14. Targets ofF14 and L14 differ by a single nucleotide. While F14 sequestered ¹⁰C andproduced an expected strong stimulatory response on SMN2 exon 7inclusion, L14 that did not target ¹⁰C triggered SMN2 exon 7 skipping.The negative effect of L14 was highly surprising, since L14 fullysequestered both of the hnRNP A1 motifs. The opposite effects of F14 andL14 were observed in the context of both, the endogenous gene and theminigene containing genomic sequences from SMN2 exon 6 through exon 8.This confirmed that a specific promoter sequence and/or any regionupstream of exon 6 do not drive the antisense effect.

To validate the target specificity of F14 and L14, we took advantage ofour meticulously designed mutant minigenes. In the absence of anyoff-target effect, it is expected that the lack of annealing of ASOswith the mutated target would eliminate the antisense response. Indeed,validating the target specificity, F14 and L14 lost their ability toaffect exon 7 splicing in the mutated SMN2/I7-08 minigene. In a counterexperiment, mutant F14 and L14 that reinstated the base pairing with themutated ISS-N1 fully restored the original antisense effects. Theseresults confirmed that the antisense effects were driven by duplexesformed between ASOs and their respective intended targets. However, incase of L14, the inhibitory effect was linked to an untargeted ¹⁰C sincethe deletion of ¹⁰C reversed the effect of L14 on SMN2 exon 7 splicing(FIG. 3A). Further support for the inhibitory role of untargeted ¹⁰Ccame from SMN2/64A mutant in which ¹⁰C was replaced by ¹⁰A. Since thisC-to-A change did not affect SMN2 exon 7 splicing pattern, ¹⁰A providedan ideal substitution to probe the role of an untargeted residueimmediately upstream of L14-duplex. L14 was able to fully restore exon 7inclusion in SMN2/64A. This surprising result constitutes one of therare findings in which a target-specific antisense response was reversedby an otherwise neutral single nucleotide substitution at the untargetedposition. Our results also confirmed that the specific location ofuntargeted ¹⁰C upstream of L14-duplex with respect to the 5′ ss isresponsible for the inhibitory effect of L14. Supporting this argument,moving the target sequence away from the 5′ ss significantly decreasedthe inhibitory response of L14 (FIG. 4).

Unique Antisense Response is Modulated by a Context-SpecificLong-Distance Interaction

We used Casp3 minigene containing ISS-N1 to compare the impact of F14and L14 in the context of a heterologous system. We have earlier shownthat insertion of ISS-N1 downstream of the 5′ ss of Casp3 exon 6promotes skipping of this exon. As expected, F14 fully restored Casp3exon 6 inclusion. However, L14 also produced a noticeable stimulatoryresponse, clearly suggesting that the inhibitory effect of unsequestered¹⁰C upstream of L14 duplex is not dependent upon a linear cis-element(FIG. 5). These results provided the first evidence implicating the roleof a long-distance interaction that is generally hard (if notimpossible) to predict by available algorithms. Our subsequentexperiments with a series of deletion mutations in the second half ofintron 7 furnished the strong proof in support of such interaction(FIGS. 6, 7). Our results suggested that an unsequestered ¹⁰C inpresence of L14-duplex interacts with intron 7 sequences upstream of the3′ ss of exon 8. It is conceivable that the annealing of L14 changes thelocal structure so that ¹⁰C becomes particularly “accessible” forinteractions due to for example flipping. However, further experimentsare required to confirm this possibility. One can hypothesize that along-distance interaction with accessible ¹⁰C might interfere with acatalytic core formation at the 5′ ss of exon 7. Consequently, thecompeting 5′ ss of exon 6 becomes the favorable substrate for thetransesterification reaction leading to exon 7 skipping (FIG. 9). On theother hand, ¹⁰C sequestered in F14-duplex would be no longer availablefor interactions, leading to usage of the 5′ ss of exon 7 (FIG. 9).

Recent updates reaffirm that spliceosome complexes are massive, dynamicribonucleoprotein assemblies that undergo extensive remodeling andexchange of components as spliceosomes are constructed, activated andrecycled (Smith et al. 2008; Wahl et al. 2009; Newman and Nagai 2010).Prp8 is the largest spliceosomal protein that plays a significant rolein formation of catalytic core of spliceosome by establishing contactswith the 5′ ss, 3′ ss and branch point (Grainger and Beggs 2005). It ispossible that specific orientation of untargeted ¹⁰C preventsrecruitment of Prp8 and/or its interacting partners that include RNAhelicases with unwinding activity of RNA:RNA duplexes. Independentreports suggest that the structural rearrangement within spliceosomemust release branch point-binding complexes for the firsttransesterification reaction to take place (Golan et al. 2005; Lardelliet al. 2010). Hence, it is probable that the specific orientation of theuntargeted ¹⁰C affects release of the branch point-binding complexes.Role of specific orientation of the untargeted ¹⁰C is somewhat supportedby the observation that 5′1U-F15 ASO that has a 3′ uridine overhangeliminates the inhibitory effect associated with L14-duplex (FIG. 3B).Since the overhang is positioned opposite to ¹⁰C, one may hypothesizethat either a non-canonical base pairing with ¹⁰C partially alters theorientation of ¹⁰C or the overhang sterically shields ¹⁰C making itinaccessible. As a consequence, the inhibitory effect of untargeted ¹⁰Cis reduced. Irrespective of the possible mechanism, our results clearlyindicate that the inhibitory effect of unsequestered ¹⁰C is not linkedto differential recruitment of hnRNP A1 to ISS-N1 region since L14 andF14 were equally efficient in displacing this inhibitory factor fromISS-N1 (FIG. 8). The discovery of the prominent role of ¹⁰C in thisstudy combined with our recent report regarding splicing modulation byan 8-mer ASO targeting GC-rich sequence, we are tempted to suggest thateffect of these ASOs are realized at least in part due to directremodeling of catalytic core and not merely due to displacement of aninhibitory factor.

Despite the fact that human U2 introns have no preference for aparticular residue at the 10^(th) intronic position (Burge et al. 1999),a majority (five out of eight) of human SMN introns contain C residue atthe 10^(th) intronic position. Four of these ¹⁰Cs are also conservedbetween human and mice SMN introns. In regard to ¹⁰C of ISS-N1, theentire GC-rich sequence is not conserved between human and mouse. Itremains to be seen if evolutionary preference for ¹⁰Cs in most human SMNintrons is merely a coincidence or a part of a yet to be identifiedregulatory network. Although, not all ¹⁰C-containing SMN introns areassociated with skipping of exons, it cannot be ruled out that thespecific residues at the 10^(th) intronic position may augment/delay theprocess of catalytic core formation and intron removal. Our finding thatthe stimulatory effect in presence of the untargeted ¹⁰C was not at parwith the sequestered ¹⁰C in all contexts supports this hypothesis.

The number of reported regulatory elements in the vicinity of the 5′ ssof SMN2 exon 7 continues to grow (Singh 2007b; Hua et al. 2008; Gladmanand Chandler 2009). Majority of these cis-elements are absent in mouseSmn and seem to be specific to humans. Linear cis-elements and RNAsecondary structures define most of these regulatory elements. Deletionsand substitution mutations have been able to validate the role of all ofthe SMN cis-elements elements described so far. In this study, use of anASO-based approach was able to establish the significance of a singlecytosine residue at the 10^(th) intronic position that falls within aunique GC-rich sequence. Since several of ¹⁰C deletion/substitutionmutations did not change the splicing pattern of SMN2 exon 7 and yetreversed the antisense response, it became obvious that ¹⁰C is anintegral part of the regulatory network involving long-distance and/orsecondary interactions. Role of such interactions have been implicatedin several systems (Bartel et al. 1991; Matsuura et al. 2001; Singh etal. 2004c). Future experiments would address the detailed mechanisticaspects that define the very unique 5′ ss of a critical exon, skippingof which is associated with a major human disease.

Materials and Methods Minigenes and Expression Vectors

Minigene splicing cassettes pSMN2Δ16, SMN2/I7-8, SMN2/5A, SMN2/5G,N1Δ30-34, N1Δ25-34, Casp3Avr, Casp3ISS-N1 and SMN2/64A were describedearlier (Singh et al. 2004b, 2006, 2009). Mutations, deletions andinsertions within minigenes were introduced by PCR using PhusionHigh-Fidelity DNA polymerase (New England Biolabs). Minigene splicingcassettes Casp3-3′C1 and Casp3ISS-N13′C1 were generated by insertingTTAAATTAA sequence in Casp3Avr and Casp3ISS-N1, respectively, usingAvrII restriction site. The exact locations of TTAAATTAA sequence isshown in FIG. 5A. In Casp3-SMN5′-1 minigene the entire SMN sequence fromthe 43^(rd) position of exon 7 to 24^(th) position of intron 7 wasinserted in Casp3Avr minigene using two-step high fidelity PCR asdescribed earlier (Singh et al. 2007). The same PCR approach was used togenerate Casp3SMN2 hybrid minigene, in which the last 116 residues ofintron 5 and the entire exon 6 of Casp3 were substituted with the last116 nucleotides of intron 6, the entire exon 7 and the first 99nucleotides of intron 7 of SMN2 (FIG. 5D). All minigene constructs wereverified by sequencing. All oligonucleotides for cloning and sequencingwere obtained from Integrated DNA Technologies.

To generate a bacterial expression vector for human hnRNPA1 recombinantprotein, hnRNPA1 coding sequence was inserted in frame with thedownstream Mycobacterium xenopi GyrA intein/chitin binding domain inpTXB3 plasmid (New England Biolabs). hnRNPA1 sequence was amplified froman hnRNPA1 expression vector provided by Dr. Benoit Chabot (LaBranche etal. 1998). For cloning purposes position 51 in hnRNP A1 coding sequencewas mutated by a two-step PCR amplification. The 5′ portion of hnRNPA1was amplified with a pair of primers 5′ RNPA-imp2(GTGGTGGTACCATGGCCTCTAAGTCAGAGTCTCCTAAAGAGCCCGAACAG) (SEQ ID NO:26) and3′RNPA-U mut (CCCTCCAATaAAGAGCTTCCTCAGCTGTTCGGGCTC), (SEQ ID NO:27)where NcoI restriction site is underlined, and an A to T mutation atposition 51 is indicated by a small-case letter. This mutation istranslationally silent but destroys a SapI restriction site in a wildtype hnRNP A1. As a part of our cloning strategy a GCC codon was addedat the beginning of hnRNP A1 sequence in 5′ RNPA-imp2 primer (indicatedin italic). This codon helps to create an NcoI restriction site, whichitself contains an ATG sequence used for translation initiation. Toamplify the 3′ portion of hnRNPA1 sequence, we used a pair of primers5′RNPA-U mut (AGGAAGCTCTTtATTGGAGGGITGAGCTTTGAAAC) (SEQ ID NO:28) and3′RNPA-imp (CTGGTGGTTGCTCTTCCGCAAAATCTTCTGCCACTGCCATAGCTAC) (SEQ IDNO:29) with an A to T mutation at position 51 indicated by a small-caseletter and SapI restriction site is underlined. The 3′RNPA-imp primerdeletes the termination codon of hnRNP A1 and introduces the SapIrestriction site followed by the first codon of Mycobacterium xenopiGyrA intein fused to the last codon of hnRNPA1. This primer designguarantees that after intein-mediated cleavage of the fusion protein(see protein purification procedure) the recombinant hnRNPA1 will haveno additional amino acids at its C-terminus. The 5′ and 3′ portions ofhnRNPA1 were gel-purified and ligated in the second step PCR reactionusing the primers 5′ RNPA-imp2 and 3′RNPA-imp. The PCR productcorresponding to the full-length hnRNP A1 was gel-purified, digestedwith NcoI and Sap I and cloned between the corresponding sites of pTXB3vector. The resulting hnRNP A1 bacterial expression vector, pTXB3-A1,was confirmed by sequencing. As a result of the cloning strategy, thehnRNP A1 protein expressed from pTXB3-A1 contains one extra amino acidappended to the N-terminus.

Cell Culture

The E. coli strain ER2566 (New England Biolabs) was used for expressionof the recombinant hnRNP A1 protein. The strain was grown in LB mediumsupplemented with 100 μg/ml of ampicillin. HeLa cells obtained from theAmerican Type Culture Collection were cultured in Dulbecco's modifiedEagle's medium (DMEM) supplemented with 10% fetal bovine serum (FBS).Primary fibroblast cell line from SMA type I patient (Repository numberGM03813) was obtained from Coriell Cell Repositories. These cells weremaintained in MEM supplemented with 2 mM GlutaMAX-I and 15% FBS. Alltissue culture media and supplements were purchased from Invitrogen.

Antisense Oligonucleotides

RNA antisense oligonucleotides (ASOs) were synthesized by Dharmacon Inc.or by TriLink Biotechnologies. ASOs incorporated 2′-O-methylmodification and phosphorothioate backbone (2OMePS) as described earlier(Singh et al. 2006). LNAs containing uniform phosphorothioate backbonewere synthesized by Exiqon.

Transfections and in Vivo Splicing Assays

Transient transfections of cells with plasmid DNA and/or with ASOs wereperformed using Lipofectamine 2000 (Invitrogen) following themanufacturer's recommendations. Briefly, cells were plated 24 h prior totransfection so that their density on the day of transfection was ˜80%.Oligonucleotide concentration varied and specified in figure legends.Depending on the experiment the amount of the plasmid used fortransfection was either 0.1 or 0.8 μg. In a given experiment, the totalamount of ASO was maintained constant by adding the controloligonucleotide (5′UUGCCULYUCU3′). (SEQ ID NO:30) The transfectionefficiency of an ASO was measured in a parallel experiment with thefluorescent labeled control ASO along with the experimental ASO. TotalRNA was isolated at the indicated time points using Trizol reagent(Invitrogen). To generate cDNA reverse-transcription was carried outusing SuperScript III Reverse Transcriptase (Invitrogen) and Oligo (dT)primer (Invitrogen). Minigene-specific spliced products were identifiedusing Taq DNA polymerase (Invitrogen) and the following pairs ofprimers: P1 and P2 for SMN2 minigene (Singh et al. 2004b); P1 and P56for Casp3Avr-based minigenes (Singh et al. 2006), and N-24 and P2 forendogenous SMN (Singh et al. 2006). PCR reactions were performed in thepresence of a trace amount of [a-³²P] dATP (3000 Ci/mmole,Perkin-Elmer). Analysis and quantifications of spliced products wereperformed using a FPL-5000 Image Reader and Multi Gauge software (FujiPhoto Film Inc.). Results were confirmed by at least three independentexperiments. Standard deviation was less than 5% of mean.

Purification of hnRNP A1 Protein

E. coli ER2566 was transformed with pTXB3-A1 expression plasmid andplated on LB-agar plates containing ampicillin. A single freshly growncolony from the LB plate was inoculated into 5 ml of LB medium withampicillin and grown overnight at 37° C. The entire 5 ml of theovernight culture was then used to inoculate 500 ml of fresh LB mediumwith ampicillin, and bacterial growth continued until the OD₅₀₀ of theculture reached 0.8. At this moment the culture was shifted to 30° C.,and the protein expression was induced with 0.2 mM IPTG for 5 h. Allsubsequent steps were carried out at 4° C. The cells were harvested bycentrifugation at 6,000 rpm for 10 min (Sorvall Legend RT+ centrifuge,Thermo Scientific), and the cell pellet was re-suspended in 10 ml ofice-cold column buffer (CB) [20 mM Na-HEPES, pH 8.5, 1 mM EDTA, 500 mMNaCl] supplemented with Protease Inhibitor Cocktail (Roche). Cells werelysed by sonication on ice at 5 watts for five 10 s bursts, with 60 sintervals (Microson™ Ultra sonic cell disruptor, Misonix Inc.) followedby centrifugation at 12,000 rpm for 15 min to remove cell debris. Foraffinity chromatography, the lysate was diluted to 50 ml with ice-coldCB and slowly loaded on a chitin (New England Biolabs) column (BioRad;10 ml plastic column with a 5 ml bed volume) equilibrated at 4° C. with50 ml of CB. The column was then washed with 100 ml of CB, followed byanother wash with 50 ml of CB, in which NaCl concentration was increasedfrom 500 to 700 mM. The hnRNPA1 protein was released by inducing anon-column intein self-cleavage in the presence of DTT. To induce inteinself-cleavage, the column was quickly flushed with 15 ml of CBcontaining 50 mM DTT. The column flow was stopped, and the column wasleft overnight at 4° C. The freed hnRNPA1 protein was eluted from thecolumn with CB. Elution fractions of 1 ml were collected, and thehnRNPA1 protein was recovered in the first nine fractions. The pooledfractions were de-salted using NAP columns (GE Healthcare) and stored in50% glycerol at −80° C. The eluted protein was analyzed byelectrophoresis in 10% SDS-polyacrylamide gels, stained with Coomassieblue. Protein concentration was determined against BSA standards run ona SDS-polyacrylamide gel.

Generation of Site-Specifically Labeled RNA Probe

All synthetic RNA oligonucleotides used to generate a site-specifically³²P-labeled probe were obtained from Dharmacon Inc. The 3′ portion ofthe probe, 5DN-18 (AUUAUGAAAGUGAAUCUU) (SEQ ID NO:31), was5′-end-labeled using [γ-³²P] ATP (3000 Ci/mmole, Perkin-Elmer) and T4polynucleotide kinase (New England BioLabs) followed byphenol:chloroform extraction and ethanol precipitation. The5′-end-labeled 5DN-18 fragment was then ligated to the 5′ portion of theprobe, TSL2-U1-32 (CAUUCCUUAAAUUAAGGAGUAAGUCUGCCAGC) (SEQ ID NO:32)using T4 DNA ligase (New England Biolabs) and a bridging DNAoligonucleotide (GGAATTTAATTCCTCATTCAGACGGTCGTAATACTTTCAC). (SEQ IDNO:33) The bridging oligonucleotide was complementary to 28- and12-nucleotide-long segments on the 5′ and 3′ portions of the probe,respectively (FIG. 8B). Briefly, two RNA fragments were hybridized tothe bridging DNA by mixing 50 pmoles of 5DN-18, 50 pmoles TSL2-U1-32 and100 pmoles of bridging DNA, and 2 μL 10× DNA ligation buffer (NewEngland Biolabs) in a 16 μL reaction mixture. The mixture was heated at75° C. for 2 min and shifted to 37° C. At this point 20 units ofSuperase (Ambion) were added to the reaction mixture, and the incubationproceeded for three hours. The hybridized substrates were then ligatedby adding 20 nmoles of ATP and 400 unit of T4 DNA ligase (New EnglandBiolabs). The ligation was carried out for 4 hours at 37° C. The ligatedRNA product was gel purified in a denaturing 16% polyacrylamide gelcontaining 8 M urea. The RNA product was eluted overnight at 37° C.using the ‘crush and soak’ method (Singh et al. 2006), and precipitatedwith ethanol.

UV-Crosslinking

For UV-crosslinking under native condition, the site-specifically³²P-labeled RNA probe was first denatured at 90° C. for 3 min andrefolded at 37° C. for 1 hour. 50 ng of the refolded probe was then usedin a 50 μL crosslinking reaction containing 20 mM Tris-C1 pH 7.6, 200 mMKCl, and 2 mM MgCl₂. When needed, 0.6 μM of an ASO of interest was usedin crosslinking reaction. Initial experiments were done in nativecondition in which RNA probe was first refolded by heating at 90° C. for3 min followed by slow cooling to room temperature. Next, refolded RNAprobe and the ASO were incubated at 37° C. for 1 hour before 2.5 μg ofhnRNP A1 was added, the reaction was then moved to ambient temperature,and the incubation continued for another 10 min. The UV-crosslinking ofRNA-protein complexes was carried out on ice at a distance of 0.5 cm for15 min using a hand-held UV-transilluminator (254 nm, UVG 54, UVP).After crosslinking, the RNA was digested with lunit RNAse T1 (USB) and 1μg RNAse A (TEKnova) at 37° C. for 30 min. The cross-linked productswere resolved by electrophoresis on a 13% SDS-polyacrylamide gel, whichwas then dried and analyzed using a FPL-5000 Image Reader (Fuji PhotoFilm Inc.).

For UV-crosslinking under denaturing condition, 50 ng of the RNA probewas added to a 50 μL crosslinking reaction containing 20 mM Tris-HCl pH7.6, 200 mM KCl and 2 mM MgCl₂ with or without 0.6 μM ASO. The reactionmixture was heated to 90° C. for 3 min and moved to 37° C. for anovernight incubation. This refolding of the RNA and an ASO togetherinsures that the latter will anneal to its target sequence. Followingthe overnight incubation 2.5 μg of hnRNP A1 was added to the reaction,and it was shifted to an ambient temperature for 10 min. UV-crosslinkingand detection of RNA-hnRNP A1 crosslinked products were done similarlyas described for “native” conditions. FIG. 10 shows the putative sitesfor long distance interaction and new oligos designed to interact withthis site and with other locations in intron 7.

1. F5LNA (Targets GC-rich sequence and LDT1 in SMN2 intron 7)Oligonucleotide sequence: 5′-GCTGG-3′Oligonucleotide chemistry: Phosphorothioate backbone andlocked nucleic acid modification 2.2UP5LNA (Targets GC-rich sequence in SMN2 intron 7)Oligonucleotide sequence: 5′-TGGCA-3′Oligonucleotide chemistry: Phosphorothioate backbone andlocked nucleic acid modification 3.3UP5LNA (Targets GC-rich sequence in SMN2 intron 7)Oligonucleotide sequence: 5′-GGCAG-3′Oligonucleotide chemistry: Phosphorothioate backbone andlocked nucleic acid modification 4.TRGT16GC (Targets LDT2 in SMN2 intron 7)Oligonucleotide sequence: 5′-CCUCUGUGGACACCAG-3′ (SEQ ID NO: 62)Oligonucleotide chemistry: Phosphorothioate backbone and2′-O-methyl modification in sugar moiety LDT = Long-distance target

In a preferred embodiment, one of more oligos may be combined forexample, an intron 7 oligo combined with a long distance target oligofor a synergistic response.

REFERENCES

-   Bartel D P, Zapp M L, Green M R, Szostak J W. 1991. HIV-1 Rev    regulation involves recognition of non-Watson-Crick base pairs in    viral RNA. Cell 67:529-536.-   Bauman J, Jearawiriyapaisarn N, Kole R. 2009. Therapeutic potential    of splice-switching oligonucleotides. Oligonucleotides 19:1-14.-   Buratti E, Baralle M, Baralle F E. 2006. Defective splicing, disease    and therapy: searching for master checkpoints in exon definition.    Nucleic Acids Res 34:3494-3510.-   Buratti E, Dhir A, Lewandowska M A, Baralle F E. 2007. RNA structure    is a key regulatory element in pathological ATM and CFTR pseudoexon    inclusion events. Nucleic Acids Res 35:4369-4383.-   Burge C B, Tuschl T, Sharp P A. 1999. Splicing of precursors to    mRNAs by the spliceosomes. In The RNA world, 2nd ed. (eds. R. F.    Gesteland et al.), pp. 525-560. Cold Spring Harbor Laboratory Press,    Cold Spring Harbor, N.Y.-   Chasin L A. 2007. Searching for splicing motifs. Adv Exp Med Biol    623: 85-106.-   Cooper T A, Wan L, and Dreyfuss G. 2009. RNA and disease. Cell    136:777-793.-   David C J, Manley J L. 2008. The search for alternative splicing    regulators: new approaches offer a path to a splicing code. Genes &    Dev 22: 279-285.-   Garcia-Blanco M A. 2006. AlternativeFsplicing: therapeutic target    and tool. Prog Mol Subcell Bio 44: 47-64.-   Gladman J T, Chandler D S. 2009. Intron 7 conserved sequence    elements regulate the splicing of the SMN genes. Hum Genet 126:    833-841.-   Golas M M, Sander B, Will C L, Lührmann R, Stark H. 2005. Major    conformational change in the complex SF3b upon integration into the    spliceosomal U11/U12 di-snRNP as revealed by electron    cryomicroscopy. Mol Cell 17:869-83.-   Graveley B R. 2005. Mutually exclusive splicing of the insect Dscam    pre-mRNA directed by competing intronic RNA secondary structures.    Cell 123: 65-73.-   Grainger R J, Beggs J D. 2005. Prp8 protein: at the heart of the    spliceosome. RNA 11: 533-557.-   Hertel K J. 2008. Combinatorial control of exon recognition. J Biol    Chem 283: 1211-1215.-   Hua Y, Vickers T A, Okunola H L, Bennett C F, Krainer A R. 2008.    Antisense masking of an hnRNP A1/A2 intronic splicing silencer    corrects SMN2 splicing in transgenic mice. Am J Hum Genet 82:    834-848.-   LaBranche H, Dupuis S, Ben-David Y, Bani M R, Wellinger R J,    Chabot B. 1998. Telomere elongation by hnRNP A1 and a derivative    that interacts with telomeric repeats and telomerase. Nat Genet 19:    199-202.-   Lardelli R M, Thompson J X, Yates J R 3rd, Stevens S W. 2010.    Release of SF3 from the intron branchpoint activates the first step    of pre-mRNA splicing. RNA 16: 516-528-   Lefebvre S, Burglen L, Reboullet S, Clermont O, Burlet P, Viollet L,    Benichou B, Cruaud C, Millasseau P, Zeviani M, et al. 1995.    Identification and characterization of a spinal muscular    atrophy-determining gene. Cell 80: 1-5.-   Lin S, Fu X D. 2007. SR proteins and related factors in alternative    splicing. Adv Exp Med Biol 623: 107-122.-   Martinez-Contreras R, Cloutier P, Shkreta L, Fisette J F, Revil T,    Chabot B. 2007. hnRNP proteins and splicing control. Adv Exp Med    Biol 623: 123-147.-   Matlin A J, Moore M J. 2007. Spliceosome assembly and composition.    Adv Exp Med Biol 623: 14-35.-   Matsuura M, Noah J W, Lambowitz A M. 2001. Mechanism of    maturase-promoted group II intron splicing. EMBO J 20:7259-70.-   Newman A J, Nagai K (2010) Structural studies of the spliceosome:    blind men and an elephant. Curr Opin Struct Biol 20, 82-89.-   Nilsen T W. 2003. The spliceosome: the most complex macromolecular    machine in the cell. Bioessays 25: 1147-1149.-   Nilsen T W, Graveley B R. 2010. Expansion of eukaryotic proteome by    alternative splicing. Nature 463: 457-463.-   Ooms M, Verhoef K, Southern E, Huthoff H, Berkhout B. 2004. Probing    alternative foldings of the HIV-1 leader RNA by antisense    oligonucleotide scanning arrays. Nucleic Acids Res. 32: 819-27.-   Shepard P J, Hertel K J. 2008. Conserved RNA secondary structures    promote alternative splicing. RNA 14: 1463-1469.-   Singh N N, Androphy E J, Singh R N. 2004a. The regulation and    regulatory activities of alternative splicing of the SMN gene. Crit    Rev Eukaryot Gene Expr 14: 271-285.-   Singh N N, Androphy E J, Singh R N. 2004b. An extended inhibitory    context causes skipping of exon 7 of SMN2 in spinal muscular    atrophy. Biochem Biophys Res Commun 315: 381-388.-   Singh N N, Androphy E J, Singh R N. 2004c. In vivo selection reveals    combinatorial controls that define a critical exon in the spinal    muscular atrophy genes. RNA 10: 1291-305.-   Singh N K, Singh N N, Androphy E J, Singh R N. 2006. Splicing of a    critical exon of human Survival Motor Neuron is regulated by a    unique silencer element located in the last intron. Mol Cell Biol    26: 1333-1346.-   Singh N N, Singh R N, Androphy E J. 2007. Modulating role of RNA    structure in alternative splicing of a critical exon in the spinal    muscular atrophy genes. Nucleic Acids Res 35: 371-389.-   Singh R N. 2007a. Unfolding the mystery of alternative splicing    through a unique method of in vivo selection. Front Biosci 12:    3263-3272.-   Singh R N. 2007b. Evolving concepts on human SMN pre-mRNA splicing.    RNA Biol 4: 7-10.-   Singh N N, Shishimorova M, Cao L C, Gangwani L, Singh R N. 2009. A    short antisense oligonucleotide masking a unique intronic motif    prevents skipping of a critical exon in spinal muscular atrophy. RNA    Biol 6:341-350.-   Smith D J, Query C C, Konarska M M. 2008. “Nought may endure but    mutability”: spliceosome dynamics and the regulation of splicing.    Mol Cell 30: 657-666.-   Tazi J, Bakkour N, Stamm S. 2009. Alternative splicing and disease.    Biochim Biophys Acta 1792:14-26.-   Veedu R N, Wengel J. 2009. Locked nucleic acid as a novel class of    therapeutic agents. RNA Biol. 6, 321-323.-   Vitte J, Fassier C, Tiziano F D, Dalard C, Soave S, Roblot N, Brahe    C, Saugier-Veber P, Bonnefont J P, Melki J. 2007. Refined    characterization of the expression and stability of the SMN gene    products. Am J Pathol 171: 1269-1280.-   Wahl M C, Will C L, Lührmann R. 2009. The spliceosome: design    principles of a dynamic RNP machine. Cell 136: 701-718.-   Wang Z, Burge C B. 2008. Splicing regulation: from a parts list of    regulatory elements to an integrated splicing code. RNA 14:802-13.-   Ward A J, Cooper TA. 2010. The pathology of splicing. J Pathol 220:    152-163.

Warf M B, Diegel J V, von Hippel P H, Berglund J A. 2009. The proteinfactors MBNL1 and U2AF65 bind alternative RNA structures to regulatesplicing. Proc Natl Acad Sci USA 106:9203-9208.

-   Williams J H, Schray R C, Patterson C A, Ayitey S O, Tallent M K,    Lutz G J. 2009. Oligonucleotide-mediated survival of motor neuron    protein expression in CNS improves phenotype in a mouse model of    spinal muscular atrophy. J Neurosci 29:7633-8.-   Wirth B, Brichta L, Hahnen E. 2006. Spinal muscular atrophy and    therapeutic prospects. Prog Mol Subcell Biol 44:109-132.-   Xing Y, Lee C. 2007. Relating alternative splicing to proteome    complexity and genome evolution. Adv Exp Med Biol 623:36-49.-   Yu Y, Maroney P A, Denker J A, Zhang X H, Dybkov O, Lührmann R,    Jankowsky E, Chasin L A, Nilsen T W. 2008. Dynamic regulation of    alternative splicing by silencers that modulate 5′ splice site    competition. Cell 135:1224-1236.

Example 2 Materials and Methods

Plasmids, cells and ASOs. Construction of SMN2 minigene is describedearlier.³⁵ Construct SMN2/64A contains a C-to-A mutation in SMN2minigene and was generated by PCR using Phusion High-Fidelity DNApolymerase (New England Biolabs). HeLa cells were obtained from theAmerican Type Culture Collection and were cultured in Dulbecco'smodified Eagle's medium (DMEM) supplemented with 10% fetal bovine serum(FBS). Primary fibroblast cell line from SMA type I patient (Repositorynumber GM03813) and a healthy control (Repository number AG06814) wereobtained from Coriell Cell Repositories. These cells were maintained inMEM supplemented with 2 mM GlutaMAX-I and 15% FBS. All tissue culturemedia and supplements were purchased from Invitrogen. RNA ASOs used inour study were synthesized by Dharmacon Inc. These ASOs incorporated2′-O-methyl modification and phosphorothioate backbone (2OMePS) asdescribed earlier.

Transfections and in vivo splicing assays. Transient transfections ofcells with plasmid DNA and/or with ASOs were performed usingLipofectamine 2000 (Invitrogen) following the manufacturer'srecommendations. Briefly, cells were plated 24 h prior to transfectionso that their density on the day of transfection was ˜80%.Oligonucleotide concentration ranged from 1 to 100 nM. In a givenexperiment, the total amount of oligonucleotide was maintained constantby adding the control oligonucleotide (5′TGACATCCACTTTGCCTTTCTCTC3′)(SEQID NO: 63). Total RNA was isolated at the indicated time points usingTrizol reagent (Invitrogen). To generate cDNA reverse-transcription wascarried out using SuperScript III Reverse Transcriptase (Invitrogen) andOligo (dT) primer (Invitrogen). 1 μg and 3 μg of total RNA were used per20 μl of reaction for amplification of minigene-specific and endogenousspliced products, respectively. Minigene-specific spliced products wereidentified using Taq polymerase (Invitrogen) and the pair of primers P1and P2 for SMN2 minigenes. For PCR amplification of endogenous exons thefollowing primer combinations were used: N-24 and P2 for SMN exon 7;5′Ex4hSMN-RP (5′GGCCAAGACTGGGACCAGG3′) (SEQ ID NO: 34) and 3′SPL8(5′TGGTGTCATTTAGTGCTGCT3′)(SEQ ID NO: 35)or 5′Ex4last1192(5′AGGGCCAAGACTGGGACCAGGAAAGG3′) (SEQ ID NO: 36) and 3′Exon6SMN(5′CATATAATAGCCAGTATGATAGCC3′) (SEQ ID NO: 37) for SMN exon 5;5′Exon1SMN (5′CTGTTCCGGCGCGGCACAGGCCAG3′) (SEQ ID NO: 38) and 3′Exon4SMN(5′TCACTTTCATCTGTTGAAACTTGG3′)(SEQ ID NO: 39) for SMN exon 3. PCRreactions were performed either in the presence of a trace amount of[γ-³²P] dATP (3000 Ci/mmole) or with one of the primers being5′end-labeled. Primers were end-labeled using [γ-³²P]ATP (3000 Ci/mmole)and T4 polynucleotide kinase (NEB), followed by phenol:chloroformextraction and spinning through a Micro Bio-spin 30 ChromatographyColumn (Bio-Rad) to get rid of unincorporated [γ-³²P]ATP. Analysis andquantifications of spliced products were performed using a FPL-5000Image Reader and Multi Gauge software (Fuji Photo Film Inc.). Resultswere confirmed by at least three independent experiments.

Western blot analysis. Whole-cell extracts were prepared using ice-coldRIPA buffer (Boston BioProducts) supplemented with protease inhibitorcocktail (Roche Applied Science). Protein concentrations were determinedusing BSA Protein Assay Kit (Thermo Scientific). Cell extracts wereresolved on a 10% (w/v) SDS-PAGE gel and transferred onto polyvinylidenefluoride (BioTrace PVDF) membrane (Pall Life Sciences). The followingprimary and secondary antobodies were used: mouse monoclonal anti-SMN(BD Transduction Laboratories), mouse monoclonal anti-hnRNP Q (Sigma),rabbit polyclonal anti-Tra2 (Abcam), rabbit polyclonal anti-actin(Sigma), horseradish-peroxidase-conjugated secondary antibodies againstmouse (Sigma) and rabbit (Jackson Immuno Research). Mouse monoclonalanti-Gemin 2 and anti-Gemin 8 antibodies were kindly provided by Dr.Gideon Dreyfuss. Mouse monoclonal anti-ZPR was the same as describedearlier. In most cases, the membranes were stripped (15 min at roomtemperature) using Restore Western Blot Stripping Buffer (ThermoScientific) and re-probed. The membranes were scanned using UVPBioSpectrum AC Imaging System (UVP). Signal intensities were quantifiedusing Vision works LS Image Acquisition and Analysis software (UVP).Results were confirmed by at least three independent experiments.

Immunofluorescence analysis. Patient fibroblasts (GM03813) were culturedon coverslips and transfected with 40 nM of F8 (control) and 3UP8CY3-labeled ASOs using Lipofectamine 2000 as described above. Cells wereharvested 48 hr post-transfection, washed, fixed and processed forimmunofluorescence. Double labeling (ZPR1/SMN) was carried out bysequential incubations with anti-SMN (clone 8, BD Transductionlaboratories), Alexa 633-conjugated anti-mouse IgG secondary antibody(Molecular Probes) and then with FITC-conjugated LG1 (anti-ZPR1). Thecover slips were mounted on slides using Vectashield with DAPI (VectorLaboratories) and examined by indirect immunoflourescence using LSM510confocal microscope (Carl Ziess) equipped with 405 nm diode laser.

Results

An ultra-refined antisense microwalk revealed shortest motif forsplicing correction. Recent reports have confirmed the presence of anegative context located downstream of the 5′ splice site (5′ ss) ofSMN2 exon 7. This negative context is defined by a 15-nucleiotidecis-element, ISS-N1 that harbors two putative hnRNP A1/A2 motifs (FIG.11A). ISS-N1 partially overlaps with an octamer sequence CUGCCAGC, whichis the only GC-rich sequence in the first half of the intron 7 of humanSMN. This sequence is predicted to reside in a single-stranded regionsandwiched between two stem-loop structures (FIG. 11A). Combined with aneasy accessibility and the high GC-rich content (75%), this octamersequence has a potential to provide an ideal ASO target. However, it isnot known if a short RNA:RNA duplex formed between CUGCCAGC and an ASOcould displace an interacting protein and/or drastically change thenegative context to reverse the splicing pattern. To explore suchpossibility, we performed an ultra-refined antisense microwalkdownstream of the 5′ ss of SMN2 exon 7. All ASOs used in our studyincorporated 2′-O-methyl modification and phosphorothioate backbone(abbreviated as “2OMePS”), a widely used RNA modification with provenstability in vivo. We performed our experiments in commerciallyavailable SMA type I patient cells (GM03183), which serves as an idealsystem for testing of splicing-correcting compounds in the context ofthe disease caused by the lack of SMN1.

Our ultra-refined antisense microwalk used four groups of ASOs ofvarying sizes. The ASOs from each group sequestered 0, 1, 2 or 3residues upstream of ISS-N1. Accordingly, ASOs were named as F, 1UP, 2UPand 3UP, followed by a number representing the size of the ASO (TableA). To discriminate between the most and the least efficient ASOs, theantisense microwalk was performed at four concentrations: 1 nM, 10 nM,50 nM and 100 nM (Table A). FIG. 11 shows the splicing pattern ofrepresentative ASOs performed at 20 nM. We observed a decrease in theantisense effect on exon 7 inclusion with a decrease in the size of F,1UP and 2UP ASOs (Table A, FIG. 11B). However, the results weredrastically different with 3UP ASOs: shortening of ASOs from 14nucleotides to 8 nucleotides produced no significant changes in theirstimulatory effects on exon 7 splicing (FIG. 11B). However, thestimulatory effect drastically decreased when ASO size was furtherreduced from 8 nucleotides to 7 nucleotides. Hence, we conclude that theshortest ASO to effectively restore SMN2 exon 7 inclusion was 3UP8, an8-mer ASO that sequestered the entire octamer sequence, CUGCCAGC,discussed above. Remarkably, 3UP8 was able to fully restore SMN2 exon 7inclusion at a relatively low concentration of 50 nM (Table A).

The finding that 3UP8 restores SMN2 exon 7 inclusion marks the discoveryof the shortest ASO among ˜200 ASOs tested thus far in SMA patient cells(Table A). In addition to revealing the shortest stimulatory ASO, theultra-refined microwalk was able to accurately define the first fiveresidues (CCAGC) of ISS-N1 as the core sequence of the antisense target.Our finding of core sequence brings a parallel with seed sequencerequired for miRNA and siRNA response. Similar to seed sequence,sequestering of the core sequence was essential but not sufficient forthe antisense response. In addition to sequestration of core sequence,sequestration of additional three residues (CUG) upstream of ISS-N1 wasfound to be essential to obtain the shortest stimulatory ASO. In theabsence of the sequestration of CUG residues, an 11-nucleotide or longertarget was required for realizing the stimulatory response (Table A).Underscoring the overlapping nature of splicing cis-elements and theirhard-to-predict accessibility during the dynamic process of splicing, wefound no direct correlation between the size of ASOs and theirstimulatory response. Similarly, we found no direct correlation betweensequestration of any of the individual hnRNP A1 motifs and the level ofstimulatory response. For instance, F10 and L13 fully sequestered the1^(st) and the 2^(nd) hnRNP A1 motifs, respectively, and yet did notproduce any significant stimulatory response even at higherconcentration of 100 nM (Table A). On the other hand, 3UP8 restored SMN2exon 7 by sequestering an 8-mer motif that only partially overlaps thefirst hnRNP A1 motif.

Antisense effect is specific to base paring with the target. Havingdiscovered that a short intronic motif could be targeted for splicingmodulation of endogenous pre-mRNA, we next examined the efficacy andspecificity of short ASO in SMN2 minigene system. Here HeLa cells wereco-transfected with the minigene (0.1 μg) and an ASO of interest (50 nM)and the effect on splicing was accessed by RT-PCR. As shown in FIG. 12B,the ASO effect on splicing of minigene-derived exon 7 was consistentwith the results for the endogenous SMN2 with 3UP8 being the shortestASO to fully restore exon 7 inclusion. To compare the target specificitybetween long and short ASOs, we generated a mutant minigene, SMN2/64A.This minigene has a single C to A substitution at the first position ofISS-N1, hence has capability to weaken the RNA:RNA duplex between theantisense and the target (FIG. 12A). Indeed, our shortest ASO (3UP8)lost all its stimulatory response in SMN2/64A. As expected, a mutant8-mer ASO (3UP8/64A) that reinstated the base pairing with the mutatedtarget fully restored exon 7 inclusion in SMN2/64A minigene; at the sametime 3UP8/64A had no stimulatory effect on splicing of SMN2 minigene(FIG. 12B). Note that the stimulatory impact of 3UP8/64A in SMN2/64Aminigene was realized despite the fact that the C-to-A mutation reducedthe GC content of the target from 75% to 62.5%. Unlike 8-mer ASOs, allfour 15-mer ASOs we used effectively restored exon 7 inclusion inSMN2/64A. These results clearly suggest that an increase in ASO sizecould have drastic (negative) consequences on the specificity of theantisense response since longer ASO appear to be more “tolerant” tosingle-nucleotide mismatches.

The shortest stimulatory ASO has no off-target effect on other SMN2exons. To examine the possible off-target effect of ASOs that promoteSMN2 exon 7 inclusion in GM03183 cells, we focused on splicing of SMN2exons 3 and 5. These exons are known to undergo alternative splicing;and therefore, have a potential to regulate the levels of full-lengthSMN. We have earlier reported that a 5 nM concentration of Anti-N1 hadno detectable effect on splicing pattern of SMN2 exons 3 and 5. Here weincreased the ASO concentration to 20 and 100 nM. We chose to useAnti-N1, F14 and 3UP8 to represent the longest, the intermediate and theshortest stimulatory ASO, respectively. F8 served as a negative control.

We started with the amplification of endogenous SMN2-spliced productsusing a pair of primers located within exons 4 and 8. This primercombination provided an added advantage of simultaneous detection ofskipping of exons 5 and 7. To compare the amount of the spliced productsin broad size range, we used an end-labeled primer. As shown in FIG.13A, all three functional ASOs: Anti-N1, F14 and 3UP8, were highlyefficient in promoting exon 7 inclusion at 20 nM concentration, while F8produced no effect. None of the ASOs appeared to have a pronouncedeffect on splicing of exon 5 at both ASO concentrations. At the sametime, Anti-N1, F14 and 3UP8 caused a decrease in the amount of theco-exclusion product (mRNAs lacking both exons 5 and 7), especially at100 nM (FIG. 13A). Skipping of exon 5 was separately measured withanother primer pair that annealed to exons 4 and 6. We found nosignificant difference on effect on exon 5 splicing in cells treatedwith any of the tested ASOs (FIG. 13B). To monitor skipping of SMN2 exon3, we used a forward primer that annealed to exon 1 and the reverseprimer that annealed to exon 4. As shown in FIG. 13C, F14 and 3UP8produced no detectable change in the level of exon 3 skipping ascompared to the mock-transfected sample. Contrary to this, Anti-N1produced a substantial increase in SMN2 exon 3 skipping at 100 nM (FIG.13C). Mechanism by which Anti-N1 elicits this off target effect is notunderstood, although it clearly underscores the disadvantage of longASOs as the therapeutic molecules.

Restoration of SMN levels by shortest ASO in SMA patient cells. The nextgoal of our study was to determine whether the correction of SMN2 exon 7splicing by 3UP8 resulted in SMN protein increase in patient cells. Inparticular, we wanted to compare the stimulatory effect of 3UP8 with alonger ASO, Anti-N1. F8 served as the negative control. The experimentswere performed with 40 nM of a given ASO and protein levels weredetermined 48 hours after transfection. Simultaneously, we monitored thelevels of SMN2 exon 7 inclusion. As shown in FIG. 14A, mock-treatment(mock) or treatment with F8 did not produce any change in SMN levels(left panel) as well as in levels of SMN2 exon 7 inclusion (rightpanel). In contrast, treatment with 3UP8 resulted in a substantial upregulation of SMN levels (FIG. 14A, left panel) and SMN2 exon 7inclusion (FIG. 14A, right panel). Significantly, the effect of 3UP8 onSMN levels was comparable to the effect produced by Anti-N1 treatment.To determine whether increase in SMN levels in ASO-treated patient cellswas accompanied by a change in cellular metabolism, we performed westernblot for a number of proteins that are generally down regulated in SMA.As shown in FIG. 14A (left panel), treatment of patient cells with 3UP8was accompanied by a marked increase in the levels of Gemin 2 and Gemin8. These factors are associated with SMN complex, a macromoleculeessential for the housekeeping role of snRNP biogenesis.^(26,27) We alsoobserved an increase in the levels of ZPR1 (FIG. 14A), anotherSMN-interacting protein, reduced expression of which is associated withthe progressive loss of motor neurons.^(51.52) Interestingly, thecorrection of splicing by 3UP8 resulted in increase of levels ofsplicing factors Tra2-β1 and hnRNP Q. Tra2-β1 and hnRNP Q have beenshown to promote SMN2 exon 7 inclusion and are generally down regulatedin SMA. Thus, our findings suggest that SMN may be a part of a positivefeedback loop that provides signals to increase the levels of differentsplicing factors.

Cell division and degradation of ASOs are bound to attenuate thestimulatory effect of ASOs with respect to time. To determine thesustainability of a single 3UP8 treatment, we performed a time courseanalysis in which levels of SMN and other factors were examined at 24 hrintervals for six days. Simultaneously, we also monitored ASO effect onSMN2 exon 7 splicing. A single dose of 40 nM of 3UP8 was sufficient tosustain the increased levels of SMN for five days (FIG. 14B, leftpanel). Effect on other proteins varied with respect to time. Forexample, levels of Gemin 2, Gemin 8, ZPR1 and hnRNP Q peaked at daythree but started decreasing after that, whereas the levels of Tra2-β1reached maximum on day three and remained high till day five (FIG. 14B,left panel). As for the effect on exon 7 splicing, levels of exoninclusion remained high for two days followed by a graduate decrease(FIG. 14B, right panel). It is possible that increase in Tra2-β1 andhnRNP Q levels contributed to exon 7 inclusion.

SMA patient cells are usually deficient in SMN-containing in sub-nuclearbodies or gems. To test whether increase in SMN levels can induce itsnuclear accumulation in gems, we performed immunofluorescence analysisof 3UP8 treated GM03813 cells. Here F8 was used as a negative control.As shown in FIG. 15, transfection of cells with 3UP8 was accompanied bya profound increase in the number of gems containing SMN. We alsoobserved that 3UP8 but not F8 resulted in increase and redistribution togems of SMN-interacting protein, ZPR1 (FIG. 15). It is known that ZPR1is required for accumulation of SMN in these sub-nuclear structures. Ourfinding that 3UP8 is able to increase the number of gems confirms aproper assembly of SMN in the nucleus. This also marks the firstevidence of a stimulatory response by a very short ASO leading to themassive macromolecular reorganization in the nucleus of a patient cell.

SMA is the second most common genetic disorder of children and infantscaused by insufficient levels of SMN protein due to the loss of the SMN1gene. Presence of a defective gene, SMN2, makes SMA a unique geneticdisease that could be avoided and possibly cured by redirecting SMN2exon 7 splicing. Among several approaches to correct aberrant splicing,an ASO-based approach provides a superior alternative due to theanticipated target specificity. Size of an ASO is an importantdeterminant in success of an ASO-based strategy. Despite the expectedadvantages, it is not known if very short ASOs could anneal to thetarget and bring desired changes in a sequence-specific manner,particularly at the low nanomolar concentrations.

Here we report an 8-mer ASO (3UP8) as the shortest ASO to correct theaberrant splicing of SMN2 exon 7 in SMA patient cells. To the best ofour knowledge, this is the first report in which an 8-mer ASO is able toeffectively correct aberrant splicing in a patient cell line.Identification of this ASO was achieved through a systematic approach ofultra-refined antisense microwalk in an intronic region adjacent to the5′ ss of exon 7. The 8-mer ASO exerts its stimulatory effect throughbinding to a GC-rich sequence (CUGCCAGC) spanning from the 7^(th) to14^(th) position of intron 7 (FIG. 11). Underscoring an evolutionarysignificance, this intronic region is not conserved between human andmice.⁴² CUGCCAGC target sequence seems to be highly accessible since lownanomolar concentrations of 3UP8 fully restores SMN2 exon 7 inclusion(Table A). Consistently, the predicted secondary structure puts thistarget sequence in an internal loop flanked by terminal stem-loopstructures (FIG. 11A).²⁸

Our ultra-refined antisense microwalk with about 50 ASOs capturedrelative strength of multiple antisense targets that differed by asingle nucleotide. As a consequence, it also revealed positions of highsignificance, wherein sequestering of the last five residues (CCAGC) ofthe GC-rich target was found to be absolutely required for thestimulatory response on SMN2 exon 7 inclusion (Table A). Hence CCAGCresidues could be considered as the core motif, analogous to the seedsequence of the micro-RNA target⁵⁰ However, unlike microRNAs thatrequire assembly of a RNA-induced silencing complex (RISCs) on an 18-meror longer sequence, our antisense response is solely based on the shortRNA:RNA duplex. Based on the published reports, it is highly unlikelythat protein factors could form a stable complex with a short RNA:RNAduplex. However, we cannot rule out the possibility of secondarycontacts that might have been affected.

The GC-rich target described here does not resemble any known bindingmotif of a splicing factor, although, it overlaps with the first fiveresidues of ISS-N1, an intronic element that harbors two putative hnRNPA1 binding sites. The C residue at the first position (¹C) of ISS-N1 isnot the part of hnRNP A1 motif, yet sequestering of this position wasfound to be absolutely necessary for the antisense response. Further,several ASOs that did not sequester ¹C produced an inhibitory effecteven though they fully sequestered both hnRNP A1 motifs (data notshown). These results suggest that the stimulatory response of ASOs is acombination of effects not necessarily caused by blocking of hnRNP A1motifs.

Various mechanisms may account for the stimulatory response exerted by3UP8. The most obvious among them is the strong target affinity of 3UP8compared to an inhibitory factor that may transiently interact with thesame target during the dynamic process of splicing. It is also possiblethat the RNA:RNA duplex formed between 3UP8 and the GC-rich target helpsbring a subtle change in the RNA structure in the vicinity of the 5′ ss.Such a structural change may help improve U1 snRNP recruitment and/orthe 5′ ss recognition. We have previously shown that recruitment of U1snRNP at the 5′ ss of exon 7 is a limiting step for SMN2 exon 7inclusion. Our results also suggest that the catalytic core of splicingis not affected by a RNA:RNA duplex formed between an ASO and its targetimmediately downstream of the U1 snRNA binding site. However,dissociation of ASO from the target sequence through a helicase reactionduring the catalytic core formation could not be ruled out. In thisscenario, the same antisense will be recycled several times on differentSMN2 pre-mRNAs. This is an obvious advantage of short ASOs in anASO-based therapy because frequency of drug (ASO) administration couldbe minimized.

Our work underscores the high target specificity of very short ASOsduring RNA:RNA interactions. For instance, a single mismatch in themiddle of the target caused a drastic decrease in the stimulatoryresponse by 3UP8. On the contrary, longer ASOs tolerated this mismatchmutation due to a large duplex formed between an ASO and the target.Tolerance of mismatched mutations provides an inherent drawback andtherapeutic risk associated with longer ASOs. Consistently, highconcentrations of a 20-mer ASO (Anti-N1) targeting intron 7 produced anoff-target effect on SMN2 exon 3 splicing, whereas identicalconcentrations of 3UP8 had no effect (FIG. 13C).

Owing to the high target specificity and an efficient antisense responseby a short ASO, 3UP8 increased levels of SMN in SMA patient cells. Italso restored levels of several key proteins that are generally downregulated in SMA (FIG. 14B). These include factors involved in snRNPbiogenesis (Gemin 2 and Gemin 8) and RNA splicing (Tra2-β1 and hnRNP Q).hnRNP Q proteins have been also implicated in other aspect of RNAmetabolism, such as RNA transcription, translation, stability andtrafficking. Increase in ZPR1 in 3UP8-treated cells suggests that ashort ASO is capable of restoring SMN-interacting factors, reducedexpressions of which are associated with the progressive loss of motorneurons. Despite a gradual decrease in the levels of SMN2 exon 7inclusion after two days, high SMN levels were maintained for five daysafter single treatment with 40 nM 3UP8. These findings suggest asubstantially longer half-life of SMN owing to the stabilization of SMNthrough association with itself and/or with other factors. Consistentwith the restoration of the SMN-interacting partners, 3UP8-treated cellsshowed increased numbers of sub-nuclear bodies (gems) in the nucleus(FIG. 15).

Currently SMA has no cure, although several small compounds capable ofincreasing levels of SMN in SMA have been identified.²³ Mechanisms ofactions and side effects of these compounds remain unknown. EarlierASO-based strategies promised high target specificity and focused onlarge ASOs in the anticipation that small motifs could not be targetedby small ASOs. In general, literature is replete with studies using15-mer or longer ASOs for modulation of alternative splicing. Our workprovides the first evidence of high target specificity for a very shortASO and sets a unique precedence of pathogenic splicing modulation byRNA molecules less than half the size of the most reported ASOs.Compared to large ASOs that carry the inherent risk of partialsequestration of different kinds of small motifs and tolerate mismatchmutations, we show that the stimulatory activity of a small ASO isexclusively dependent upon the perfect match with a single motif that isuniquely located within an accessible region of a negative context.Short ASOs offer additional advantages including low cost of synthesis,ease of chemical modifications, reduced chances of immune response, andhigher probability of crossing biological barriers.⁵⁸ When promotion ofexon inclusion is the goal, a short intronic target brings the desiredbenefits of non-interference with nuclear export and translation. Hence,our findings represent further advancement towards an ASO-based therapyof SMA and bring a unique perspective to our understanding of splicingregulation of a defective gene associated with a major genetic diseaseof children and infants.

REFERENCES

-   1. Xing Y, Lee C. Relating alternative splicing to proteome    complexity and genome evolution. Adv Exp Med Biol 2007; 623:36-49.-   2. Nilsen T W. The spliceosome: the most complex macromolecular    machine in the cell. Bioessays 2003; 25:1147-49.-   3. Matlin A J, Moore M J. Spliceosome assembly and composition. Adv    Exp Med Biol 2007; 623:14-35.-   4. Hertel, K J. Combinatorial control of exon recognition. J Biol    Chem 2008; 283:1211-15.-   5. Lin S, Fu X D. SR proteins and related factors in alternative    splicing. Adv Exp Med Biol 2007, 623: 107-122.-   6. Martinez-Contreras R, Cloutier P, Shkreta L, Fisette J F, Revil    T, Chabot B. hnRNP proteins and splicing control. Adv Exp Med Biol    2007, 623: 123-147.-   7. Singh R N. Unfolding the mystery of alternative splicing through    a unique method of in vivo selection. Front Biosci 2007; 12:    3263-3272.-   8. Chasin L A. Searching for splicing motifs. Adv Exp Med Biol 2007;    623: 85-106.-   9. David C J, Manley J L. The search for alternative splicing    regulators: new approaches offer a path to a splicing code. Genes    Dev 2008; 22:279-85.-   10. Wang Z, Burge C B. Splicing regulation: from a parts list of    regulatory elements to an integrated splicing code. RNA 2008;    14:802-13.-   11. Buratti E, Baralle F E. Influence of RNA secondary structure on    the pre-mRNA splicing process. Mol Cell Biol 2004; 24:10505-14.-   12. Graveley B R. Mutually exclusive splicing of the insect Dscam    pre-mRNA directed by competing intronic RNA secondary structures.    Cell 2005; 123:65-73.-   13. Singh N N, Singh R N, Androphy E J. Modulating role of RNA    structure in alternative splicing of a critical exon in the spinal    muscular atrophy genes. Nucleic Acids Res 2007; 35:371-89.-   14. Hiller M, Zhang Z, Backofen R, Stamm S. Pre-mRNA secondary    structures influence exon recognition. PLoS Genet 2007; 3:e204.-   15. Cooper T A, Wan L, Dreyfuss G. RNA and disease. Cell 2009;    136:777-93.-   16. Garcia-Blanco M A 2006. Alternative splicing: therapeutic target    and tool. Prog Mol Subcell Biol 2006; 44:47-64.-   17. Madsen E C, Morcos P A, Mendelsohn B A, Gitlin J D. In vivo    correction of a Menkes disease model using antisense    oligonucleotides. Proc Natl Acad Sci USA. 2008; 105: 3909-14.-   18. van Deutekom J C, Janson A A, Ginjaar I B, Frankhuizen W S,    Aartsma-Rus A, Bremmer-Bout M, den Dunnen J T, Koop K, van der Kooi    A J, Goemans N M, de Kimpe S J, Ekhart P F, Venneker E H, Platenburg    G J, Verschuuren J J, van Ommen G J. Local dystrophin restoration    with antisense oligonucleotide PRO051. N Engl J Med 2008;    357:2677-86.-   19. Bauman J, Jearawiriyapaisarn N, Kole R. Therapeutic potential of    splice switching oligonucleotides. Oligonucleotides 2009; 19:1-14.-   20. Lefebvre S, Burglen L, Reboullet S, Clermont O, Burlet P,    Viollet L, Benichou B, Cruaud C, Millasseau P, Zeviani M, LePaslier    D, Frezal F, Cohen D, Weissenbach J, Munnich A, Melki J.    Identification and characterization of a spinal muscular    atrophy-determining gene. Cell 1995; 80:1-5.-   21. Vitte J, Fassier C, Tiziano F D, Dalard C, Soave S, Roblot N,    Brahe C, Saugier-Veber P, Bonnefont J P, Melki J. Refined    characterization of the expression and stability of the SMN gene    products. Am J Pathol 2007; 171:1269-80.-   22. Hsieh-Li H M, Chang J G, Jong Y J, Wu M H, Wang N M, Tsai C H,    Li H. A mouse model for spinal muscular atrophy. Nat Genet 2002; 24:    66-70.-   23. Wirth B, Brichta L, Hahnen E. Spinal muscular atrophy and    therapeutic prospects. Prog Mol Subcell Biol 2006; 44: 109-32.-   24. Corcia P, Camu W, Praline J, Gordon P H, Vourch P, Andres C. The    importance of the SMN genes in the genetics of sporadic ALS.    Amyotroph Lateral Scler 2009; 6:1-5.-   25. Turner B J, Parkinson N J, Davies K E, Talbot K. Survival motor    neuron deficiency enhances progression in an amyotrophic lateral    sclerosis mouse model. Neurobiol Dis. 2009 Mar. 27. PMID: 19332122-   26. Gabanella F, Butchbach M E, Saieva L, Carissimi C, Burghes A H,    Pellizzoni, L. Ribonucleoprotein assembly defects correlate with    spinal muscular atrophy severity and preferentially affect a subset    of spliceosomal snRNPs. PLoS. ONE 2007; 2: e921.-   27. Zhang Z, Lotti F, Dittmar K, Younis I, Wan L, Kasim M,    Dreyfuss G. SMN deficiency causes tissue-specific perturbations in    the repertoire of snRNAs and widespread defects in splicing. Cell    2008; 133:585-600.-   28. Singh N N, Androphy E J, Singh R N. The regulation and    regulatory activities of alternative splicing of the SMN gene. Crit.    Rev. Eukaryote Gene Expr 2004; 14:271-85.-   29. Singh R N. Evolving concepts on human SMN pre-mRNA splicing. RNA    Biol. 2007; 4: 7-10.-   30. Kashima T, Rao N, Manley J L. An intronic element contributes to    splicing repression in spinal muscular atrophy. Proc Natl Acad Sci    USA 2007; 104:3426-31.-   31. Scholl R, Marquis J, Meyer K, Schümperli D. Spinal muscular    atrophy: position and functional importance of the branch site    preceding SMN exon 7. RNA Biol. 2007; 4:34-7.-   32. Martins de Araüjo M, Bonnal S, Hastings M L, Krainer A R,    Valcárcel J. Differential 3′ splice site recognition of SMN1 and    SMN2 transcripts by U2AF and U2 snRNP. RNA 2009; 15:515-23.-   33. Cartegni L, Krainer A R. Disruption of an SF2/ASF-dependent    exonic splicing enhancer in SMN2 causes spinal muscular atrophy in    the absence of SMN1. Nat Genet 2002; 30:377-384.-   34. Kashima T, Manley J L. A negative element in SMN2 exon 7    inhibits splicing in spinal muscular atrophy. Nat Genet 2003;    34:460-63.-   35. Singh N N, Androphy E J, Singh R N. An extended inhibitory    context causes skipping of exon 7 of SMN2 in spinal muscular    atrophy. Biochem Biophys Res Commun 2004; 315: 381-88.-   36. Cartegni L, Hastings M L, Calarco J A, de Stanchina E, Krainer    A R. Determinants of exon 7 splicing in the spinal muscular atrophy    genes, SMN1 and SMN2. Am J Hum Genet 2006; 78:63-77.-   37. Singh N N, Androphy E J, Singh R N. In vivo selection reveals    combinatorial controls that define a critical exon in the spinal    muscular atrophy genes. RNA 2004; 10:1291-305.-   38. Hofmann Y, Lorson C L, Stamm S, Androphy E J, Wirth B.    Htra2-beta 1 stimulates an exonic splicing enhancer and can restore    full-length SMN expression to survival motor neuron 2 (SMN2). Proc    Natl Acad Sci USA 2000; 97:9618-23.-   39. Hua Y, Vickers T A, Baker B F, Bennett C F, Krainer A R.    Enhancement of SMN2 exon 7 inclusion by antisense oligonucleotides    targeting the exon. PLoS Biol 2007; 5:e73.-   40. Miyajima H, Miyaso H, Okumura M, Kurisu J, Imaizumi K.    Identification of a cis-acting element for the regulation of SMN    exon 7 splicing. J Biol Chem 2002; 277:23271-77.-   41. Miyaso H, Okumura M, Kondo S, Higashide S, Miyajima H,    Imaizumi K. An intronic splicing enhancer element in Survival Motor    Neuron (SMN) pre-mRNA. J Biol Chem 2003; 278:15825-31.-   42. Singh N K, Singh N N, Androphy E J, Singh R N. Splicing of a    critical exon of human Survival Motor Neuron is regulated by a    unique silencer element located in the last intron. Mol Cell Biol    2006; 26:1333-46.-   43. Hua Y, Vickers T A, Okunola H L, Bennett C F, Krainer A R.    Antisense masking of an hnRNP A1/A2 intronic splicing silencer    corrects SMN2 splicing in transgenic mice. Am J Hum Genet 2008;    82:834-48.-   44. Cartegni L, Krainer A R. Correction of disease-associated exon    skipping by synthetic exon-specific activators. Nat Struct Biol    2003; 10:120-25.-   45. Skordis L A, Dunckley, M G, Yue B, Eperon I C, Muntoni F.    Bifunctional antisense oligonucleotides provide a trans-acting    splicing enhancer that stimulates SMN2 gene expression in patient    fibroblasts. Proc Natl Acad Sci USA 2003; 100:4114-19.-   46. Marquis J, Meyer K, Angehrn L, Kämpfer S S, Rothen-Rutishauser    B, Schümperli D. Spinal muscular atrophy: SMN2 pre-mRNA splicing    corrected by a U7 snRNA derivative carrying a splicing enhancer    sequence. Mol Ther 2007; 15:1479-86.-   47. Coady T H, Baughan T D, Shababi M, Passini M A, Lorson C L.    Development of a single vector system that enhances trans-splicing    of SMN2 transcripts. PLoS. ONE 2008; 3:e3468.-   48. Lim S R, Hertel K J. Modulation of survival motor neuron    pre-mRNA splicing by inhibition of alternative 3′ splice site    pairing. J Biol Chem 2001; 276:45476-83.-   49. Madocsai C, Lim S R, Geib T, Lam B J, Hertel K J. Correction of    SMN2 Pre-mRNA splicing by antisense U7 small nuclear RNAs. Mol Ther    2005; 12:1013-22.-   50. Rana T M. Illuminating the silence: understanding the structure    and function of small RNAs. Nat Rev Mol Cell Biol 2007; 8:23-36.-   51. Gangwani L, Mikrut M, Theroux S, Sharma M, Davis R J. Spinal    muscular atrophy disrupts the interaction of ZPR1 with the SMN    protein. Nat Cell Biol 2001; 3:376-83.-   52. Doran B, Gherbesi N, Hendricks G, Flavell R A, Davis R J,    Gangwani L. Deficiency of the zinc finger protein ZPR1 causes    neurodegeneration. Proc Natl Acad Sci USA 2006; 103:7471-75.-   53. Helmken C, Hofmann Y, Schoenen F, Oprea G, Raschke H,    Rudnik-Schöneborn S, Zerres K, Wirth B. Evidence for a modifying    pathway in SMA discordant families: reduced SMN level decreases the    amount of its interacting partners and Htra2-beta1. Hum Genet 2003;    114:11-21.-   54. Rossoll W, Kroning A K, Ohndorf U M, Steegborn C, Jablonka S,    Sendtner M. Specific interaction of Smn, the spinal muscular atrophy    determining gene product, with hnRNP-R and gry-rbp/hnRNP-Q: a role    for Smn in RNA processing in motor axons. Hum Mol Genet 2002;    11:93-105.-   55. Chen H H, Chang, J G, Lu R M, Peng T Y, Tarn, W Y. The RNA    binding protein hnRNP Q modulates the utilization of exon 7 in the    survival motor neuron 2 (SMN2) gene. Mol Cell Biol 2008; 28:6929-38.-   56. Lefebvre S, Burlet P, Liu Q, Bertrandy S, Clermont O, Munnich A,    Dreyfuss G, Melki J. Correlation between severity and SMN protein    level in spinal muscular atrophy. Nat Genet 1997; 16:265-69.-   57. Gangwani L, Flavell R A, Davis R J. ZPR1 is essential for    survival and is required for localization of the survival motor    neurons (SMN) protein to Cajal bodies. Mol Cell Biol 2005;    25:2744-56.-   58. Jaeger L B, Banks W A. Transport of antisense across the    Blood-brain barrier. In: Methods in Molecular Medicine: Antisense    Therapeutics (ed. Phillips, M. I., Humana Press, Totowa, N.J.) 2005;    106:237-51.

TABLE AEffect of ASOs on skipping of SMN2 exon 7 in SMA type 1 fibroblasts(GM03183). SEQ ID NOS 40-61

Cells were transfected with 1, 10, 50 and 100 nM of ASOs and the totalRNA for splicing assay was isolated 24 h post transfection. First 29residues of intron 7 of human SMN are shown in small-case letters.Numbering starts from position 1 of intron 7. GC-rich sequence ishighlighted in pink. Positions of ISS-N1 residues are boxed. Two hnRNPA1 motifs within ISS-N1 are indicated.⁴³ First five residues of ISS-N1constitute the core of the antisense target and are marked as “CORE” andhighlighted in blue. Sequences of ASOs are shown in large case lettersin 3′ to 5′ direction and are arranged against the target sequence ofintron 7. Percentage of SMN2 exon 7 skipping is shown on the right.Values highlighted in blue, green and light green colors represent 10%or less, 25% or less and 40% or less exon 7 skipping, respectively.Values highlighted in tan color represent no appreciable effect on SMN2exon 7 splicing. Mock transfection (without any ASO) produced 50% ofSMN2 exon 7 skipping.

The contents of any patents, patent applications, and references citedthroughout this specification are hereby incorporated by reference intheir entireties.

Those skilled in the art will recognize, or be able to ascertain usingno more than routine experimentation, many equivalents to the specificembodiments of the invention described herein. Such equivalents areintended to be encompassed by the following claims.

1. An isolated oligonucleotide reagent comprising: a nucleotide sequencewhich is complementary to nucleotide ¹⁰C and 3 or more bases 5′ thereofof intron 7 of the SMN2 gene.
 2. The isolated oligonucleotide reagent ofclaim 1, said oligonucleotide reagent having 8 or fewer nucleotides andwhich is complementary to nucleotides 7-14 of intron 7 of the SMN2 gene.3. The isolated oligonucleotide reagent of claim 1, said isolatedoligonucleotide reagent having a sequence complementary to the sequence5′-CUGCCAGC-3′.
 4. The isolated oligonucleotide reagent of claim 1, saidisolated oligonucleotide reagent having a sequence complementary to thesequence 5′-CUGCC-3′.
 5. The isolated oligonucleotide reagent of claim1, comprising the sequence 5′-GCUGGCAG-3′.
 6. The isolatedoligonucleotide reagent of claim 1, comprising the sequence 5′-GGCAG-3′.7. The isolated oligonucleotide reagent of claim 1, said isolatedoligonucleotide sequence having a sequence complementary to 5 or morebases from the sequence 5′-CUGGUGUCCACAGAGGAC-3′ (SEQ ID NO:3).
 8. Theisolated oligonucleotide reagent of claim 1, said isolatedoligonucleotide reagent comprising a complementary sequence greater than80% identical to the sequence 5′-CUGGUGUCCACAGAGGAC-3′ (SEQ ID NO:3). 9.The oligonucleotide of claim 1, wherein the oligonucleotide is modifiedby the substitution of at least one nucleotide with a modifiednucleotide, such that in vivo stability is enhanced as compared to acorresponding unmodified oligonucleotide.
 10. The oligonucleotide ofclaim 9, wherein the modified nucleotide is a sugar-modified nucleotide.11. The oligonucleotide of claim 9, wherein the modified nucleotide is anucleobase-modified nucleotide.
 12. The oligonucleotide of claim 19,wherein the modified nucleotide is a 2′-deoxy ribonucleotide.
 13. Theoligonucleotide of claim 12, wherein the 2′-deoxy ribonucleotide is2′-deoxy adenosine or 2′-deoxy guanosine.
 14. The oligonucleotide ofclaim 9, wherein the modified nucleotide is a 2′-O-methylribonucleotide.
 15. The oligonucleotide of claim 9, wherein the modifiednucleotide is selected from the group consisting of a 2′-fluoro,2′-amino and 2′-thio modified ribonucleotide.
 16. The oligonucleotide ofclaim 9, wherein the modified nucleotide is selected from the groupconsisting of 2′-fluoro-cytidine, 2′-fluoro-uridine,2′-fluoro-adenosine, 2′-fluoro-guanosine, 2′-amino-cytidine,2′-amino-uridine, 2′-amino-adenosine, 2′-amino-guanosine and2′-amino-butyryl-pyrene-uridine.
 17. The oligonucleotide of claim 9,wherein the modified nucleotide is selected from the group consisting of5-bromo-uridine, 5-iodo-uridine, 5-methyl-cytidine, ribo-thymidine,2-aminopurine, 5-fluoro-cytidine, and 5-fluoro-uridine,2,6-diaminopurine, 4-thio-uridine, and 5-amino-allyl-uridine.
 18. Theoligonucleotide of claim 9, wherein the modified nucleotide is abackbone-modified nucleotide.
 19. The oligonucleotide of claim 18,wherein the backbone-modified nucleotide contains a phosphorothioategroup.
 20. The oligonucleotide of claim 9, wherein the modifiednucleotide is a locked nucleic acid (LNA).
 21. A composition comprisingthe oligonucleotide of claim
 1. 22. The composition of claim 21, furthercomprising a pharmaceutical carrier.
 23. A method of enhancing the levelof exon 7-containing SMN2 mRNA relative to exon-deleted SMN2 mRNA in acell or cell extract, comprising contacting the cell or cell extractwith the oligonucleotide of claim 1, such that the level of exon7-containing SMN2 mRNA relative to exon-deleted SMN2 mRNA in the cell orcell extract is enhanced.
 24. The method of claim 23, wherein the cellor cell extract is a spinal muscular atrophy (SMA) patient-derivedneuronal cell, muscle cell or fibroblast, or extract thereof.
 25. Themethod of claim 23, wherein the cell or cell extract is selected fromthe group consisting of an embryonic stem cell, an embryonic stem cellextract, a neuronal stem cell and a neuronal stem cell extract.
 26. Amethod of enhancing the level of exon 7-containing SMN2 mRNA relative toexon-deleted SMN2 mRNA in an organism, comprising administering to theorganism the oligonucleotide of claim 1, such that the level of exon7-containing SMN2 mRNA relative to exon-deleted SMN2 mRNA in theorganism extract is enhanced.
 27. The method of claim 26, wherein theorganism is a mammal.
 28. The method of claim 27, wherein the organismis a human.
 29. The method of claim 28, wherein the human has spinalmuscular atrophy (SMA).
 30. A method of treating spinal muscular atrophy(SMA) in a patient, comprising administering to the patient theoligonucleotide of claim 1 in a dose effective to enhance the level ofexon 7-containing SMN2 mRNA relative to exon-deleted SMN2 mRNA in cellsof the patient, such that SMA in the patient is treated.
 31. A methodfor inhibiting an SMN2 pre-mRNA intronic splicing silencer site in acell or cell comprising contacting the cell with the oligonucleotide ofclaim 1, such that the SMN2 intronic splicing silencer site isinhibited.
 32. A method of enhancing the level of exon 7-containing SMN2mRNA relative to exon-deleted SMN2 mRNA in a cell or cell extract,comprising contacting the cell or cell extract with the oligonucleotideof claim 7, such that the level of exon 7-containing SMN2 mRNA relativeto exon-deleted SMN2 mRNA in the cell or cell extract is enhanced. 33.The method of claim 32, wherein the cell or cell extract is a spinalmuscular atrophy (SMA) patient-derived neuronal cell, muscle cell orfibroblast, or extract thereof.
 34. The method of claim 32, wherein thecell or cell extract is selected from the group consisting of anembryonic stem cell, an embryonic stem cell extract, a neuronal stemcell and a neuronal stem cell extract.
 35. A method of enhancing thelevel of exon 7-containing SMN2 mRNA relative to exon-deleted SMN2 mRNAin an organism, comprising administering to the organism theoligonucleotide of claim 7, such that the level of exon 7-containingSMN2 mRNA relative to exon-deleted SMN2 mRNA in the organism extract isenhanced.
 36. The method of claim 35, wherein the organism is a mammal.37. The method of claim 36, wherein the organism is a human.
 38. Themethod of claim 37, wherein the human has spinal muscular atrophy (SMA).39. A method of treating spinal muscular atrophy (SMA) in a patient,comprising administering to the patient the oligonucleotide of claim 7in a dose effective to enhance the level of exon 7-containing SMN2 mRNArelative to exon-deleted SMN2 mRNA in cells of the patient, such thatSMA in the patient is treated.
 40. A method for inhibiting an SMN2pre-mRNA intronic splicing silencer site in a cell or cell comprisingcontacting the cell with the oligonucleotide of claim 7, such that theSMN2 intronic splicing silencer site is inhibited.